Ureteric Reimplantation - Unilateral

Unilateral ureteric reimplantation

Unilateral ureteric reimplantation is a medical operation done to address the issues with one ureter; the tube that transfers urine out of one kidney directing it to the bladder. The usual purpose of the procedure is to enable the urine to drain freely and avert injury to the kidney (for example, infection, hydronephrosis, or trauma). This procedure may be done open, laparoscopically or robotically based on the surgeon's preference and the patient's needs. 

Benefits of the Surgery 

• Prevention of long-term kidney damage. 
• Prevention of recurrent UTIs. 
• Regulates reflux / obstruction permanently.
• Rejuvenates normal urinary function.

Ureteric reimplantation surgery unilateral

When only one ureter (urine carrying tube from the kidney to the bladder) is moved or adjusted, the surgery is called unilateral ureteral reimplantation. This will allow for normal urine flow and prevent the swelling of the kidney (hydronephrosis), infections, or reflux.

Why is it performed?

The surgery may be recommended for the following unilateral ureteric conditions:

Vesicoureteral Reflux (VUR) 

• Reverse flow of urine in the bladder toward the bladder kidney.

Stricture / Narrowing of the Ureters 

• Poses an obstruction and hydronephrosis.

Iatrogenic Injury

• Ureteral trauma during pelvic surgery (e.g. hysterectomy). 

Obstructed Megaureter

• Ureter dilated and atonic. 

Ureterocele or ureteral anomaly 

• Causing blockage.

Childhood congenital problems

• Leading to recurrent UTIs or poor kidney drainage

Categories of Surgical Procedures

Open Reimplantation

• Traditional method
• Excellent results
• Improved healing increased surgery.
• Common in pediatric cases

Laparoscopic Reimplantation

• Keyhole surgery
• Smaller incisions
• Faster discharge
• Less pain

Robotic Reimplantation

• Most advanced technique
• Indicated in case of complicated strictures or reoperation.
• Excellent resolution and increased visualization.
• The least amount of blood lost, shortest time to recovery.

Unilateral ureteric reimplantation procedure

Unilateral ureteric reimplantation is an operation that is carried out to repair or reposition one of the ureters to allow free flow of urine out of the kidney to the bladder. It could be widely applied to treat vesicoureteral reflux (VUR), obstruction in the ureter, stricture, or damage of one ureter.

Pre-operative Preparation

• Complete examination: ultrasound, MCU, CT scan or renal scan.
• Blood and urine tests
• Antibiotics (when infected)
• Fasting for 6–8 hours
• It is supposed to be general anaesthesia.

Surgical procedure step-by-step

Step 1: Anaesthesia and Position.

• General anaesthesia performed to patient.
• Lying (lying on his back).

Step 2: Bladder and Ureter access.

• Incision is done (open or laparoscopic port incisions).
• The bladder is exposed.
• The involved ureter is worked out and accurately mobilized to where there is healthy tissue.

Step 3: Abnormal Segment (Where Necessary) Excision.

• In case of stricture, damaged section, or blocked section, the same is removed.
• Sound ends of the ureters are spared.

Step 4: Submucosal Tunnel in Bladder created.

• A hiatus is formed on the bladder wall.
• An inner tunnel is made in the bladder, which is submucosal.
• This tunnel is used as a valve mechanism to avoid urine reflux.

Step 5: Reimplantation of Ureter.

• Ureter is put into new tunnel via the bladder wall.
• The ureter is attached using fine absorbable sutures.
• Tapering may be done in case the ureter is unnaturally broad (megaureter).

Step 6: JJ Stent Placement

• A double J or JJ stent is a thin plastic tube which is placed between the kidney and the urinary bladder. 

• This makes the ureter not close during recovery and avoids obstruction.

Step 7: Bladder and Wound Closure.

• The bladder is closed in layers.
• Incisions or port sites are closed.
• A catheter is retained in the bladder between 1-3 days.

Duration of Surgery

• Open: 1.5–2 hours

• Laparoscopic/Robotic: 2–3 hours

• Increased in case of tapering.

Post-operative Care

Hospital stay:

• Open: 2–4 days
• Laparoscopic/Robotic: 1–2 days
• Catheter removal: after 1–3 days
• Stent removal: after 4–6 weeks
• Follow-up scans after 6–12 weeks

Expected Recovery

• Go back to light exercises: 1-2 weeks.
• Full recovery: 3–4 weeks
• Children recover faster
• The pain is normally mild to moderate and treated by medication.

Success Rate

• Success 90-98% in the resolution of reflux, obstruction or injury.
• In complicated disorders, robotic method is the most accurate.

Extravesical ureteric reimplantation unilateral

Extravesical ureteric reimplantation is the surgery involves repairing one of the ureters without opening the bladder cavity. Rather, that surgeon performs the operation on the bladder outside, establishing a new passageway of the ureter.

It is such a common form of therapy in children as well as adults in the case of vesicoureteral reflux (VUR) or lower ureteric obstruction.

Unilateral ureteric reimplantation recovery

Recovery from unilateral ureteric reimplantation is typically uneventful and especially so when a single ureter requires reimplantation. The healing process after minimally invasive (laparoscopic/robotic assisted) surgery is faster than that after open surgery. 

Hospital Recovery Timeline

Day 0 – Surgery Day

• Wake up with urinary catheter.
• Light to moderate pain in the area of the lower abdomen.
• You can experience spasms in the bladder (usual).

Day 1–2

• Catheter generally removed in 24 -48 hours.
• You will be permitted to walk, eat, and drink at a normal rate.

Dismissal normally occurs in:

• Open surgery: 2–3 days
• Laparoscopic/Robotic: 1–2 days

At-Home Recovery (Week-by-week)

Week 1

• Light stomach pain or burning of the urine.
• Light walking encouraged.
• Avoid strenuous activity.
• Drink plenty of water.
• Keep taking prescription drugs (painkillers, antibiotics).

Week 2–3

• Most patients feel 70–80% normal.
• Incision healing well.
• Children heal even faster (they are usually active in 2-3 weeks).

Week 4

• Engage in moderate physical exercise.
• Majority of the adults are capable of going back to work unless it involves heavy lifting.

After 4–6 Weeks

• JJ stent removal (if placed).
• After removing the stents, urination returns to its normal state.
• Repeat ultrasound or a renal scan can be done.

Activity Restrictions

Avoid for 4–6 weeks:

• Heavy lifting
• Vigorous or vigorous exercise.
• Squatting and bending, bending and squatting.
• At least 2-3 weeks of sexual activity.
• Swimming until incision healed.

Pediatric unilateral ureteric reimplantation

Unilateral Ureteric reimplantation is a surgery on one ureter in a child to correct a urinary tract defect that can cause kidney damage, repeated infections of the urinary tract, or has urine going backward into the ureter. It is among the most prevalent pediatric urology surgeries and has great long-term outcome.

Forms of Surgical Interventions in Children

Extravesical (Lich Gregoir Technique)

• Common for unilateral cases
• Bladder is not opened
• Less pain, faster recovery
• Low probability of urinary retention.

Intravesical (Cohen Cross-Trigon Technique)

• Bladder opened and ureter tunneled in.
• Most suitable in complicated reflux or extreme ureter dilation.
• Slightly longer recovery

Robotic or Laparoscopic

• Keyhole surgery
• Applied in specific situations in older children or complicated cases.
• Least pain, fastest recovery

With or Without Tapering

• Tapering (narrowing) can be done in case ureter is much dilated.

Best hospital for unilateral ureteric reimplantation India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Unilateral ureteric reimplantation is a very effective and safe operation which is aimed at correcting reflux, obstruction or congenital abnormality of one ureter. It has a success rate of above 95 percent and provides good long-term renal protection and lowers the occurrence of recurrent urinary tract infection by a significant margin. Recent surgical methods, particularly the extravesical and minimally invasive procedures, can be performed with a faster recovery rate, reduced pain, and few complications. The majority of children are able to resume normal functioning in a few weeks, and long-term prognoses are absolutely favorable. Through appropriate follow-ups and early intercession, such surgery is equivalent to healthy urinary drainage and normal kidney growth and development.

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FAQ

1. Are children safe in the surgery?

• Yes. It is a common pediatric urology operation, highly successful (95-98) and low rate of complications.

2. Will my child have pain?

• The discomfort is usually mild to moderate and can be relieved with drugs. Extravesical and the least invasive approaches are the least painful. 

3. Is the surgery a permanent cure or obstruction?

• Yes. The cure rate of the procedure long-term is 95-98 percent particularly when there is a unilateral occurrence.

4. Should my child have a long-term follow-up?

• Yes. The follow- up involves ultrasound after 6 weeks and regular check up to make sure that there is good kidney growth and proper drainage.