Reimplantation

Ureteric reimplant operation is performed to remove obstruction in ureter. This is as safe as any other traditional surgeries and blood transfusion may not be necessary. Laparoscopic ureteral reimplantation is a minimally invasive alternative to the open approach and has a success rate of 95.8% among adults undergoing various procedures including psoas hitch, psoas hitch plus Boari flap, and extravesical ureteral reimplantation

Length of Surgery:

3- 4 hours.

Diagnosis:

Procedure of Ureteric reimplnat(Ureteroneocystostomy) is preceded by following diagnosis tests:

  • Physical exam and complete Medical history.
  • KUB ( abdominal X-ray)
  • EKG (electrocardiogram)
  • CBC (complete blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Panel (blood chemistry profile)
  • Urinalysis
  • Renal ultrasound: grade of hydronephrosis?
  • Intravenous urography or abdominal CT
  • Endoscopy: Retrograde pyelography and ureterorenoscopy
  • cystoscopy

Treatment:

Treatment for ureteral stricture,depends on the length of the defect, location, etiology (due to injury, infection and obstruction, and time of diagnosis

Ureteroneocystostomy is suitable for the treatment of distal ureteral strictures up to 4–5 cm of length.
– Psoas hitch technique, (tacking the posterior bladder wall to the psoas muscle) -6–10
cm of ureter can be replaced
– Boari-flap technique(tubularization of a flap of bladder to extend from the bladder
to the ureteral orifice)- 12–15 cm of ureter can be replaced.

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Aspirin.
  • Ibuprofen Motrin.
  • Voltaren, Plavix, Lovenox, Vioxx, Celebrex.
  • Advil, Ticlid, Alka Seltzer, Coumadin, Vitamin E.
  • Arthritis medications: avoided since before a week of the surgery otherwise it can cause bleeding during the surgery.
  • In case of UTI Urinary Tract Infection, it should be treated before the surgery by prescribed antibiotics.
  • In case of severe lung/ heart conditions, it is advisable to exercise extra caution before and during the procedure
  • Ureteric reimplant (, ureteroneocystostomy) operation is performed under general anesthesia in both adults and children
  • Prior or during the surgery , patient should free of urinary tract infection.
  • It may be empirical to perform cystoscopy before operation

Procedure:

Ureteroneocystostomy (UNC) is surgical procedure to reimplantation of the ureter into the bladder . This is performed used for treatment of obstruction or fistula in the adults and for surgical treatment of vesicoureteral reflux (VUR) in children.
Psoas hitch-
The psoas hitch technique is the procedure of choice to correct ureteral defects close to the bladder such as distal ureteral injury, ureteral fistulae secondary to pelvic surgery, segmental resection of a distal ureteral tumor, and failed ureteroneocystostomy.
Boari flap-
This procedure is done when the defective segment of ureter is very much long or ureter is fixed and can not to moved. Boari flaps can be crafted to correct a 10- to 15-cm defect. Indications in the pediatric population
Ureteroneocystostomy is open surgical procedure performed with the patient in a supine position, with padding under the knees.
Surgeon takes a Pfannenstiel incision in children, whereas for adults a Pfannenstiel or lower midline incision is used. Next, by freeing the peritoneal attachments , the urinary bladder is mobilized. After identifying ureter , it is cut proximal to the defective segment. Different approaches for Ureteroneocystostomy such as a modified Politano-Leadbetter type of repair and an extravesical Lich-Gregoir. Can be resorted.

Alternatively, Ureteral reimplantation can be carried out by laparoscopic, transvesicoscopic, and robotic-assisted procedures .

Risks:

  • Bleeding after the operation
  • Infection
  • Poor wound healing ( following open surgery)
  • Fever.
  • Fatigue.
  • Urinary abnormalities.
  • Acute postoperative complications :
  • Extravasation of urine
  • Ureteral obstruction
  • Hematuria
  • Bladder spasms
  • Delayed complications
  • Persistent reflux
  • Contralateral reflux
  • Ureteral obstruction
  • Urinary fistul
  • Mobilization: Important to begin walking a day after surgery, to prevent blood clots.

Follow- up:

  • 24 hour surveillance.
  • Visit doctor: for removal of cathedral after surgery.
  • Emergency Follow up:
  • Chest pain/ breathing difficulty.
  • Vomiting/ nausea
  • Worsening pain .
  • Large amounts of blood clots in the urine.
  • Difficult/ painful voiding and fully emptying the bladder.
  • Hospital stay for one to three days after radical prostatectomy.
  • During the operation, urinary catheter is inserted and few patients may be required to wear the catheter for some
  • more days to a few weeks even after discharge from hospital.
  • Retaining catheter kept in skin after surgery should be there for some more days after discharge from hospital.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.