Name of the Procedure:

Ureterostomy (Transplantation of Ureter to Skin)

Summary

A ureterostomy is a surgical procedure where the ureter, the tube that carries urine from the kidney to the bladder, is diverted and attached directly to the skin. This creates a new opening for urine to exit the body, bypassing the bladder.

Purpose

This procedure addresses issues like severe bladder dysfunction or damage that prevents urine from being stored or passed normally. The goal is to allow urine to safely exit the body, alleviate the symptoms of urinary retention or incontinence, and prevent kidney damage.

Indications

• Severe bladder dysfunction or damage due to conditions like cancer, spinal cord injuries, or chronic inflammation.
• Urinary retention unresponsive to other treatments.
• Recurrent urinary tract infections (UTIs) causing complications. Patients suitable for this procedure are typically those who have not found relief from less invasive treatments.

Preparation

• Patients may need to fast for several hours before surgery.
• Preoperative blood tests, imaging studies like ultrasounds or CT scans, and a thorough medical evaluation.
• Temporary cessation of certain medications, such as blood thinners.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A small incision is made in the abdominal wall.
3. Mobilization: The ureter is carefully detached from the bladder.
4. Transplantation: The ureter is then attached directly to an opening created in the skin.
5. Stoma Creation: A new stoma (opening) is formed on the skin surface through which urine will drain.
6. Closing: The incision is closed with sutures or staples, and a stoma bag is applied to collect urine.

Tools and equipment include surgical instruments for cutting and stitching, and possibly imaging equipment to guide the surgeon.

Duration

The procedure typically takes 2 to 4 hours.

Setting

Usually performed in a hospital's surgical suite.

Personnel

• Surgeons specializing in urology or general surgery
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Common risks: Infection, bleeding, and stoma-related issues (e.g., irritation or blockage).
• Rare risks: Kidney damage, blood clot formation, and metabolic imbalances.

Benefits

The main benefits are the effective elimination of urine retention, prevention of recurrent UTIs, and protection of kidney function. Most patients start to feel the benefits within a few days to weeks after the surgery.

Recovery

• Patients usually stay in the hospital for 3 to 7 days.
• Post-operative care includes pain management, monitoring for signs of infection, and stoma care education.
• Light activities may be resumed in 2-3 weeks, but full recovery might take up to 6 weeks.
• Follow-up visits will be necessary to monitor the stoma and overall health.

Alternatives

• Other options include catheterization, dialysis, intermittent self-catheterization, or less invasive bladder surgeries.
• Alternatives may be less invasive but might not provide the same level of symptom relief.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Postoperatively, there may be discomfort at the incision site and around the stoma. Pain management will be provided through medications. Patients will need to learn how to care for the stoma and manage the stoma bag, with nursing support available to guide them through this adjustment.