Dr Jo Schoeman
Urological Surgeon

        

Ureteric Reimplantation

Product Summary: AMA rates

Surgical repair of PUJ obstruction, Laparoscopic or open

Item Number: 36564, 105

Mainly a procedure for paediatric urology to correct grade 4-5 vesicoureteric reflux

Why is it done?

  • Grade 4-5 Vesico-Ureteric Reflux where conservative management has failed with a progressive deterioration in renal function.
  • Distal ureterectomy due to stricture disease.
  • Iatrogenic injury to lower ureter during surgical procedure: hysterectomy, colectomy, sacro-colpo-pexy etc.
  • Ureteric involvement in pelvic oncological (cancer) conditions, ie: colon cancer, rectal cancer, ovarian cancer, etc.
  • Ureteric involvement in pelvic inflammatory conditions: Diverticular abcesses, Pelvic Inflammatory disease etc.

How is it done?

  • Patients will receive a general anaesthesia.
  • Prophylactic antibiotics is given.
  • The correct kidney is identified and marked while you are awake.
  • This will be an combined open surgical and endoscopic procedure.
  • A Cystoscopy will be done with placement of ureteric catheter or stent, if not already done.
  • Patients with complete closure of the ureter may have a nephrostomy tube into their kidney via the back.
  • An indwelling catheter is placed.
  • A midline lower abdominal incision is made, and the pelvic cavity is entered.
  • The ureter is identified and the affected area of the lower ureter is identified and cut off above the injury / diseased area.
  • The bladder is opened, Bi-valved and the the ureter is re-implanted either as refluxing or non refluxing.
  • A Psoas-hitch procedure will be performed where the bladder is fixed onto the affected side’s Psoas muscle as to take off tension from the anastomosis / reimplantation.
  • A Boari-flap may be considered with considerable length of defect.
  • In the case of VUR, the ureter is not cut, rather loosened in the bladder and retunnelled in a non refluxing technique under the mucosa of the bladder. Several techniques have been described.
  • An ureteric stent is placed for 6 weeks and an indwelling catheter for 10 days.
  • A drain is also placed for post-operative drainage for a couple of days.

VUR grades

What next?

  • You may be in hospital for at least 3-5 days.
  • You may have continuous intravenous antibiotics on board.
  • You will have a drain and an indwelling catheter.
  • The drain will be removed on D2-3 as soon as the drainage is less than 20-30cc per 24 hours.
  • The indwelling catheter will remain for 10 days until a cystogram reveals no leaks.
  • Your stent will be removed on a separate occasion in 6 weeks after all the fibrosis has settled.
  • A ward prescription may be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks to remove the stent.
  • A further follow-up is arranged with a CT IVP to check on the end result of the ureter.
  • Don’t hesitate to ask Jo if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Possible complications:

  • Vesico - Ureteric Reflux.
  • Stricturing / Narrowing of the implanted ureter.
  • Persistent Reflux.
  • Re-implantation.
  • VUR.
  • Stenosis and narrowing with persistent hydronephrosis.

Ureteric Reimplantation Ureteric Reimplantation (366 KB)