Name of the Procedure:

Ureteroenterostomy, Direct Anastomosis of Ureter to Intestine

Summary

Ureteroenterostomy is a surgical procedure where the ureter, the tube that carries urine from the kidney, is directly connected to the intestine. This allows urine to bypass the bladder and flow directly into the intestine.

Purpose

This procedure is usually performed to address issues when the bladder is not functioning properly, such as severe bladder cancer, damage from radiation therapy, or other medical conditions that prevent the bladder from storing urine. The goal is to create an alternative pathway for urine drainage to improve the patient's quality of life and prevent kidney damage.

Indications

• Bladder cancer
• Severe, untreatable bladder dysfunction
• Chronic inflammatory diseases of the bladder
• Radiation damage to the bladder
• Congenital abnormalities affecting the bladder

Patient criteria:

• Adequate kidney function
• Sufficiently healthy intestinal tissue
• Ability to tolerate major surgery

Preparation

• Fasting for at least 8 hours before the procedure
• Preoperative bowel preparation
• Suspension of certain medications like blood thinners
• Preoperative blood tests, imaging studies, and possibly cardiac evaluation

Procedure Description

1. The patient is placed under general anesthesia.
2. The surgeon makes an incision in the abdomen to access the ureters and intestine.
3. The ureter is separated from the bladder.
4. A segment of the intestine is isolated and prepared for anastomosis.
5. The ureter is directly connected (anastomosed) to the prepared segment of the intestine.
6. The incision is closed, and any necessary drainage tubes are placed.

Tools and Equipment:

• Surgical scalpels and retractors
• Anastomosis sutures or staples
• General anesthesia equipment

Duration

The procedure typically takes 3 to 5 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Urologic surgeon
• Surgical assistants
• Anesthesiologist
• Operating room nurses

Risks and Complications

Common risks:

• Infection
• Bleeding
• Urine leakage at the anastomosis site

Rare risks:

• Blood clots
• Intestinal blockage
• Electrolyte imbalances

Benefits

• Relief from symptoms related to bladder dysfunction
• Prevention of kidney damage
• Improved quality of life

Patients may start to see benefits within weeks post-surgery as healing progresses.

Recovery

• Hospital stay for 5-7 days post-procedure
• Limited physical activity for 4-6 weeks
• Adequate hydration and nutritional intake
• Regular follow-up appointments to monitor healing and function

Alternatives

• Ileal conduit (using a section of the small intestine to create a new urinary channel)
• Bladder reconstruction or augmentation

Pros and cons of alternatives:

• Ileal conduit: less complex but requires an external urostomy bag
• Bladder reconstruction: more complex and may not be suitable for all patients depending on the extent of bladder damage

Patient Experience

During:

• Patients are under general anesthesia and will not feel anything during the procedure.

After:

• Some pain and discomfort managed with pain medication
• Possible temporary use of a catheter or drainage tubes
• Gradual return to normal activities with specific instructions from the healthcare team

Pain management involves medication prescribed by the healthcare provider and measures to ensure comfort during recovery.