Ureteral Reimplantation Surgery
The ureters are the tubes that carry urine from the kidneys to the bladder. The connection where one or both of your child’s ureters attach to the bladder isn’t completely developed. This can cause urine to flow from the bladder back up into the kidney. This is called vesicoureteral reflux (VUR). VUR doesn’t cause pain. But it can increase your child’s risk for urinary tract infections (UTIs). Over time, it can also damage your child’s kidneys. With ureteral reimplantation surgery, one or both ureters are moved so their connection to the bladder is stronger and the urine drains well and does not flow backwards.
Preparing for surgery
Prepare your child for the surgery as told. In addition:
Tell the doctor about any medicines your child takes. Your child may need to stop taking some or all of them before surgery, as directed by the doctor.
Follow any directions your child is given for not eating or drinking before surgery.
The day of surgery
The surgery takes about 2 to 3 hours. Your child will stay in the hospital for 1 to 2 days afterward.
Before the surgery begins:
An intravenous (IV) line is placed in a vein in your child’s arm or hand. This line supplies fluids and medicines (such as antibiotics).
To keep your child from feeling pain during the surgery, general anesthesia is given. This medicine lets your child sleep comfortably through the surgery. A tube may be inserted into your child’s throat to help with breathing.
A thin tube (catheter) may be placed into your child’s bladder to drain urine.
During the surgery:
An incision is made in your child’s lower abdomen (belly), just above the pubic bone. The end of the ureter and some muscle near it are detached from the bladder.
The doctor will decide where in the bladder to reimplant the ureter. A tunnel is then created for the ureter to be placed inside.
The ureter is moved to the new site in the bladder and inserted into the tunnel.
Once the ureter is in place, it is secured with stitches.
If the other ureter is also being treated, it is done so at this time.
The bladder is stitched closed.
The skin incision made in the abdomen is closed with stitches or surgical tape.
A small tube (drain) is placed near the incision. This drain removes fluid that can build up after the surgery.
Recovering in the hospital
After the surgery, your child will be taken to a recovery room to be monitored as the anesthesia wears off. At first, he or she may feel sleepy, nauseated, and have a sore throat (if a breathing tube was used). If needed, medicine will be given to manage pain. When your child is ready, he or she will be moved to a hospital room. The urinary catheter will be removed before your child leaves the hospital. The drain may also be removed. If the child is sent home with the drain, you will be shown how to care for it at home.
Recovering at home
Follow the doctor’s instructions for how to care for your child at home. Be sure to:
Give your child medicine as directed.
Care for your child’s incision and drain as instructed.
Follow the doctor’s guidelines for bathing your child.
Don’t allow your child to be active until the doctor says it’s OK.
Ask the doctor when your child can return to daycare or school.
When to call your child's healthcare provider
Call your child's healthcare provider right away if your child has any of the following:
Chest pain or trouble breathing (call 911)
Fever of 100.4°F (38°C) or higher, or as directed by the healthcare provider
Symptoms of infection at an incision site such as increased redness or swelling, warmth, worsening pain, or foul-smelling drainage
Problems with the drain
Dark blood or clots in the urine (some pink-tinged urine is normal)
Inability to urinate
Inconsolable crying or refusal to feed (infants)
At follow-up visits, the doctor will check how well your child is healing. If needed, your child’s stitches and drain will be removed in about 7 days. Tests, such as an ultrasound of the kidneys, may be done 1 to 3 months after the procedure. These allow the doctor to check that your child’s urinary tract is working properly.
Risks and possible complications
Bleeding (may require a blood transfusion)
Urine leakage from the ureters
Stricture of ureters returns
Damage to the bladder, bowels, or other organs
Risks of anesthesia (the anesthesiologist will discuss these with you)
October 08, 2017
Smith, Hinman's Atlas of Urologic Surgery (2012), 3rd Ed, pp 353-35
Greenstein, Marc, DO,Sather, Rita, RN