Definition

The ureters are the tubes that carry urine from the kidneys to the bladder. Ureteral reimplantation is surgery to change the position of these tubes where they enter the bladder wall.

Alternative Names

Ureteroneocystostomy - children; Ureteral reimplant surgery - children; Ureteral reimplant; Reflux in children - ureteral reimplantation

Description

This procedure changes the way the ureter is attached to the bladder.

The surgery takes place in the hospital while your child is asleep and pain-free. The surgery takes 2 to 3 hours.

During surgery, the surgeon will:

• Detach the ureter from the bladder.
• Create a new tunnel between the bladder wall and muscle in a better position in the bladder.
• Place the ureter in the new tunnel.
• Stitch the ureter in place and close the bladder with stitches.
• If needed, this will be done to the other ureter.
• Close any cut made in your child's belly with stitches or staples.

The surgery can be done in 3 ways. The method used will depend on your child's condition and how the ureters need to be reattached to the bladder.

• In open surgery, the surgeon will make a small incision in the lower belly through muscle and fat.
• In laparoscopic surgery, the surgeon will perform the procedure using a camera and small surgical tools through 3 or 4 small cuts in the belly.
• Robotic surgery is similar to laparoscopic surgery, except that the instruments are held in place by a robot. The surgeon controls the robot.

Your child will be discharged 1 to 2 days after the surgery.

Why the Procedure Is Performed

The surgery is done to prevent urine from flowing backwards from the bladder to the kidneys. This is called reflux, and it can cause repeat urinary tract infections and damage the kidneys.

This type of surgery is common in children for reflux due to a birth defect of the urinary system. In older children, it may be done to treat reflux due to injury or disease.

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Reactions to medicines

Risks for this procedure are:

• Urine leaking out into the space around the bladder
• Blood in the urine
• Kidney infection
• Bladder spasms
• Blockage of the ureters
• It may not fix the problem

Long-term risks include:

• Persistent back flow of urine into the kidneys
• Urinary fistula

Before the Procedure

You will be given specific eating and drinking instructions based on your child's age. Your child's doctor may recommend that you:

• Do not give your child any solid foods or non-clear liquids, such as milk and orange juice, starting at midnight before the surgery.
• Give only clear liquids, such as apple juice, to older children up to 2 hours before surgery.
• Breastfeed children up to 4 hours before surgery. Formula-fed babies may feed up to 6 hours before surgery.
• Do not give your child anything to drink for 2 hours before the surgery.
• Only give your child medicines the doctor recommends.

After the Procedure

After surgery, your child will receive fluids in a vein (IV). Along with this, your child may also be given medicine to relieve pain and calm bladder spasms.

Your child may have a catheter, a tube that will come from your child's bladder to drain the urine. There also may be a drain in your child's belly to let fluids drain after surgery. These may be removed before your child is discharged. If not, the doctor will tell you how to care for them and when to come back to have them removed.

When your child comes out of anesthesia, your child may cry, be fussy or confused, and feel sick or vomit. These reactions are normal and will go away with time.

Your child will need to stay in the hospital for 1 to 2 days, depending on the type of surgery your child had.

Outlook (Prognosis)

The surgery is successful in most children.

References

Elder JS. Vesicoureteral reflux. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 554.

Khoury AE, Wehbi E. Management strategies for vesicoureteral reflux. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 29.

Olsen LH, Rawashdeh YFH. Surgery of the ureter in children: ureteropelvic junction, megaureter, and vesicoureteral reflux. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 42.

Pope JC. Ureteroneocystostomy. In: Smith JA Jr, Howards SS, Preminger GM, Dmochowski RR, eds. Hinman's Atlas of Urologic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 33.