Name of the Procedure:

Ureterorrhaphy, suture of ureter (separate procedure).

Summary

Ureterorrhaphy is a surgical procedure involving the suturing or stitching of the ureter, a tube that carries urine from the kidneys to the bladder. This procedure aims to repair any damage or injury to the ureter.

Purpose

Ureterorrhaphy is performed to address injuries or defects in the ureter caused by trauma, surgical complications, or disease. The goal is to restore the normal flow of urine from the kidney to the bladder, prevent urine leakage, and avoid kidney damage.

Indications

• Trauma or injury to the ureter.
• Surgical complications leading to ureteral damage.
• Ureteral strictures or blockages.
• Vesicoureteral reflux (backflow of urine from the bladder to the kidney).

Preparation

• Pre-procedure fasting as advised by the doctor.
• Discontinuation or adjustment of certain medications such as blood thinners.
• Diagnostic imaging tests like CT scans, ultrasounds, or urography to assess the ureter.
• Blood tests to evaluate kidney function and overall health.

Procedure Description

1. Anesthesia is administered to ensure the patient is comfortable and pain-free.
2. An incision is made to access the ureter.
3. The damaged or injured section of the ureter is identified.
4. The edges of the ureter are brought together and sutured to close any tears or gaps.
5. The incision is closed with stitches or staples, and a drainage tube may be placed to prevent fluid accumulation.
6. A stent may be inserted into the ureter to maintain patency during healing.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and extent of the injury.

Setting

Ureterorrhaphy is usually performed in a hospital operating room.

Personnel

• Surgeon (usually a urologist).
• Anesthesiologist.
• Surgical nurses and technicians.

Risks and Complications

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Ureteral fistula (abnormal connection between the ureter and another structure).
• Stricture (narrowing) of the ureter.
• Recurrent ureteral injury or leakage.
• Kidney damage.

Benefits

• Restores normal urine flow.
• Prevents further complications like infections or kidney damage.
• Alleviates symptoms such as pain and urinary incontinence.
• Enhances overall kidney function.

Recovery

• Hospital stay of 3 to 7 days post-procedure.
• Pain management with medications.
• Instructions for caring for the surgical site.
• Avoid strenuous activities and heavy lifting for a few weeks.
• Follow-up appointments to monitor healing and remove any stents or drains.

Alternatives

• Observation and conservative management for minor injuries.
• Endoscopic procedures to repair minor ureteral defects.
• Ureteral reimplantation for severe cases.
• Pros: Less invasive options may involve shorter recovery times.
• Cons: May not be suitable for significant or severe injuries requiring surgical intervention.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel any pain. Post-operatively, some discomfort or pain is expected but can be managed with medication. The patient may need to manage a drainage tube and follow specific care instructions to ensure proper healing and recovery. Regular follow-ups are essential to monitor progress and address any issues promptly.