Ureterostomy Bilateral

Ureterostomy bilateral surgery

Bilateral ureterostomy is a medical surgery that involves the direct diversion of both the ureters into the abdominal wall, which forms a urine drainage stomas outside the body. This is mostly done when the bladder is nonfunctional or when it requires bypassing because of disease, injury, or malignancy.

Indications

Unilateral ureterostomy can be advised in the situations of:

• Bladder cancer that calls cystectomy.
• Bladder flaws in congenital state.
• Severe bladder dysfunction or neurogenic bladder.
• Radiation or infection damage of the bladder.
• Not amenable to reconstruction, ureteral strictures or obstruction.

Bilateral ureterostomy procedure India

The bilateral ureterostomy procedure is a procedure that follows a step-by-step process as outlined below:

Preoperative Preparation

• Investigations: Blood tests, tests of renal functions, urine culture, imaging (ultrasound, CT urography)
• Bowel Prep: Sometimes mandatory in case of an abdominal approach.
• Anaesthesia: General anaesthesia is used.
• Position of patient: Supine position on the operating table.

Surgical Steps

Step 1: Abdominal Access

• The surgeon incises the lower abdomen midline or transversely (open surgery) or in small keyholes (laparoscopic surgery).
• The belly is examined, and both ureters are detected.

Step 2: Ureter Mobilization

• Every ureters is cautiously excised out of the tissues, without compromising the blood.
• In case of need, diseased or damaged areas of ureters can be excised.
• Ureters are ready to make stoma by cutting its ends to healthy tissue.

Step 3: Stoma Site Preparation

• The abdominal wall is marked bilaterally at the stoma position typically at the lower quadrants to facilitate the attaching of the bags.
• Preparation of the skin is done and an incision made on the ureters.

Step 4: Ureteral Implantation

• Both ureters are passed through the openings in the abdominal walls.
• To form a stoma, a spatulated ureter end is sutured to the skin.
• Small stents or catheters can be occasionally introduced in the ureters to guarantee the free flow of the urine in the initial stages of the healing process.

Step 5: Securing the Ureters

• Ureters are attached not to be retracted or kinked.
• The presence of urine through the stomas is established.

Step 6: Closure

• Close on abdominal incision is in layers.
• There is dressing of stomas and the use of drainage bags.

Postoperative Care

• Check urine flow, color of stoma, and infection.
• Analgesic management of pain.
• Early walking to avoid such complications as blood clots.
• Teach patient/caregivers how to take care of stoma and urostomy bags.
• To confirm adequate ureteral drainage and renal function, follow-up imaging.

Key Points

• Operation time: 2-4 hours based on the complexity.
• Hospital stay: 5–10 days
• The removal of temporary stents can be done in 2-4 weeks.
• Stoma care throughout life is necessary.

Factors Affecting Ureterostomy bilateral surgery cost

In the case of a bilateral ureterostomy (both ureters stoma fixed), a range of factors can have a considerable impact on the overall cost. The main cost-drivers are as below:

Pre-operative health/comorbidities of patient

• When the patient has other conditions (e.g., diabetes, hypertension, obesity, previous radiation, impaired kidney, etc.) this can predispose, pre-operative testing, post-operative monitoring, intensive care, and hospitalization. 
• Prior surgeries or anatomical complications may make the process more difficult and extend the duration of the operation, which consumes more resources (ICU, blood tests, imaging) and thus more costs.

Complexity of procedure and method of surgery

• Bilateral (rather than unilateral) ureterostomy is more complicated: 2 ureters are mobilised, passed to the abdominal wall, and stoma are made, which allows sufficient blood flow, and it prevents complications.
• In case a more sophisticated (laparoscopic/robotic) compared to a conventional open technology is utilized, the expenses will be increased (equipment, increased OR time).
• The cost driver is the time the operation lasts: in a ureteroscopy study, the time in the OR was an important cost driver. 
• Other interventions (e.g. bowel segment required as conduit, stents, additional drains) are excessively costly.

Inpatient and outpatient treatment

• The duration of hospitalization, ICU, or normal ward, a requirement of prolonged monitoring or complications (e.g., infection, stoma problems) is all costly. 
• Post-operative supplies: stoma bags, special dresses, high frequency changes, follow-up visits, renal kidney/ureter imaging.

Hospital type and room type

• Hospitals of superior quality, urban centres, and international patient bundles are more expensive. Considering the example, a diagram of bilateral ureterostomy in a leading hospital in Delhi was quoted in USD. 
• Room (deluxe, private or shared), hospital facilities/brand is also in the cost.

Surgeon charges, anaesthesia, man power, supplies

• More often experienced surgeons, multidisciplinary teams (urology + surgical oncology + plastic/stoma care) are more expensive.
• The type of anaesthesia (general with monitoring, longer) is more expensive.
• OR equipment, disposables (sutures, stents, drains) have costs of increase in case of implants (some are included).

Pre- and post-operative research and comorbidity care

• Imaging (CT, MRI, ultrasound), Labs (renal function, electrolytes), cardiology clearance (patient has comorbidities).
• Post-op: imaging follow-up, visits by a stoma care nurse, potential readmission, wound/stoma complication.

Complications & readmissions

• Complications such as infection, obstruction of the ureteral tubes, re-surgery may arise and make it very expensive.
• Preventive vs reactive care: good stoma placement, patient education, early intervention is a cheaper downstream care.

Pediatric bilateral ureterostomy surgery

Pediatric bilateral ureterostomy is an operation in which the urine tubes in both urine stones in a child are redirected to the stomach wall to create stomas through which the urine can flow. It is done in case of nonfunctionality or obstruction of the bladder or its bypassing necessitated by various reasons such as congenital abnormalities, serious infections or malignancy.

Indications in Children

• Congenital abnormalities of the bladder: e.g. bladder exstrophy, posterior UVR.
• Neurogenic bladder: usually secondary to spina bifida.
• Unresponsive severe type of vesicoureteral reflux.
• UTI obstruction or ureteral strictures.
• Bladder malignancy or post- cystectomy.
• Past urinary diversion or reconstructive surgeries that fail.

Best hospital for ureterostomy bilateral India

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

Conclusion

Bilateral ureterostomy is a life-saving surgery applied to children who have a severe bladder or ureteral abnormality, which cannot be repaired with the help of conservative or reconstructive surgery. This surgical procedure:

• Defends kidney functionality by averting reverse impact and hindrance.
• Treats extreme urinary tract diseases including congenital anomalies, neurogenic bladder, or obstruction.
• Enhances the quality of life, so that safe and continuous urine drainage is possible.

Although it is not dangerous, it is important to note that the surgery needs close attention in the postoperative period such as stoma care, infection monitoring, and long-term follow-up to guarantee that the renal functioning remains intact. Children can have normal and active lives when they are well cared and supported. Bilateral ureterostomy is a procedure that can be permanent but in most cases it is lifesaving or life-enhancing, especially in complicated cases in pediatric urology.

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FAQ

Is the procedure permanent?

• It is a permanent or long-term solution in most of the pediatric cases but in certain instances, later on, reconstructive surgery can be performed to form a continent urinary diversion.

Will the child be able to live a normal life post-surgery?

• Yes. Through good stoma care and follow up, children are able to develop, play, and engage in normal activities. Periodic checks of kidney functioning are done to guarantee the long-term health.

What are the substitutes of bilateral ureterostomy?

• Some other options can be made such as reconstructive surgery of the bladder, urinary conduits, or temporary diversion procedures, which depend on the age of the child, his or her anatomy, and general state.

What is the price of pediatric bilateral ureterostomy?

• The price is very diverse, it depends on a hospital, a surgeon, complexity and location. It consists of: surgeon fees, hospital stay, anaesthesia, consumables, stoma supplies and follow-up care. Complexes or long-term care may add to expenses.