Ureterostomy Closure Bilateral

Ureterostomy closure bilateral surgery

Bilateral ureterostomy is a medical operation in which both ureters are brought out in the abdominal area which allows the urine to leave the body, normally performed when the bladder is unable to hold or pass urine through normal methods. Bilateral ureterostomy closure is a reconstructive surgery whereby there is a restoration of the normal urinary pathway normally by reconnecting the ureters to the bladder or a neobladder where possible.

Signs of Bilateral Ureterostomy Closure

The surgery can be prescribed in case:

• The urinary reservoir or bladder of the patient is now functional.
• The patient has also received the correctional surgery of the bladder dysfunction or obstruction.
• Long term ureterostomy is prone to infection or complications.
• This is desired to improve the quality of life without external urine collection bags.

Bilateral ureterostomy closure procedure India

Bilateral ureterostomy is done to redirect the normal flow of the urine to the bladder (or a urinary reservoir) by rejoining the two ureters internally to remove the external stomas.

Preoperative Preparation

Medical Evaluation

• Blood tests: Kidney functioning (serum creatinine, BUN), CBC.
• Urine culture to exclude the infection.
• Imaging: Ureters and kidneys: Ultrasound, CT urogram, or IVP.
• Bladder test: Cystogram or urodynamic examination to determine bladder preparedness.

Patient Optimization

• Treat a urinary tract infection.
• Proper nutritional deficiencies.
• Talk about surgical plan, risks and recovery.

Surgical Steps

• Anaesthesia: General anaesthesia is done.
• Incision: Abdominal incision over the former sites of ureterostomy or lower midline incision.
• Ureter Identification: The ureters are dissected at the sites of the stoma.

Bladder/Reservoir Preparation:

• Ureteral reimplantation is prepared with bladder or neobladder.
• In case of small or non-functioning bladder, neobladder can be made with intestinal tissue.

Ureteral Reimplantation (Ureteronecystostomy):

• Tunneling and reinsertion of ureters on the bladder or neobladder.
• This will avoid refluxing of urine and proper drainage.
• Stent Placement: Ureteral stents can be placed temporarily to maintain ureters.

Closure:

• Abdominal layers are sealed; the drains can be installed to avoid the accumulation of fluids.
• Catheterization: 1-2 weeks of bladder drainage with the help of a Foley catheter.
• Expected Time: 3 to 5 hours based on complications and remnants of past surgery.

Postoperative Care

• Hospital Stay: 7–10 days.
• Drain & Catheter Care: Drains should be removed when the output is reduced; typically, catheters are removed after 1-2 weeks.
• Lately: Painkillers, antibiotics, and occasionally antispasmodictives.
• Follow-Up: Imaging or renal functional evidence to guarantee the ureters and kidneys are performing well.

Factors Affecting Ureterostomy closure bilateral surgery cost

These are the key variables that would determine the Cost of bilateral ureterostomy closure India:

Complexity of the surgery

• It could be a plain ureteral re-implantation, in comparison with other complicated reconstruction (adhesions, prior surgical procedure, bilateral, long ureteral mobilization).
• The extra costs will include the use of other procedures (neobladder creation, augmentation, previous stoma closure).
• The longer the time of operation, the more the number of surgical staff, the more risk, the higher the cost.

Hospital type, accreditation & technology

• A small facility will be cheaper compared to a modern tertiary hospital with a private infrastructure and ICU.
• Certified hospitals (e.g. NABH, JCI) tend to be more expensive.
• The fee will increase with the use of high-technology (laparoscopic, robotic). Example in nephrectomy cost lap verses open. 

Location & city of hospital

• The costs are more likely to be higher in metropolitan cities (Delhi NCR, Mumbai, Bengaluru) than in tier-2/3 cities, because of the increased overheads. 
• Employed to international patients: travel and accommodation on top of the cost of surgery.

Pre-treatment assessment and diagnostic procedures

• Imaging (CT-scans, IVP, ultrasounds), laboratory tests, consultations increase the cost.
• Additional investigations and optimisation are needed in case there are comorbidities (renal impairment, previous infections).

Room category, postoperative care

• Hospital stay (long stays in bilateral, complicated cases) augments cost.
• Model of room (general ward and single deluxe) is a consideration. 
• ICU, drains, stents, ancillary required elevate expenses.

Surgeon & anaesthesia fees

• More will be paid to experienced urologist/uro-surgeon.
• Anaesthesia: general or regional, special monitoring is expensive. 

Use of consumables & implants

• Stents in the ureters, grafts (where necessary), special equipment are all expensive.
• Surgeries done again can have scar tissue, additional consumables.

Complications/risk factor multiplier

• The cost may increase in case of problems (infection, the necessity of a longer stay) occurred.
• The overall condition of the patient (kidney problems, previous operations) might require additional activities and attention.

In case of international patients: exchange rate, travel, stay, coordination fees

• Medical tourism introduces the expenses of travel, accommodation, translator/liaison, visa, etc.
• Potential price charge on foreign-patient packages, as well.

Best hospital for ureterostomy closure bilateral India

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

Conclusion

The bilateral ureterostomy closure is a complicated yet one of the most valuable reconstruction surgical operation which tries to reestablish normal urine flow of both kidneys to the bladder or a urinary reservoir. Successful closure will help to eliminate the necessity of urged collection of urine, decrease the risk of infections and also increase the quality of life significantly. The operation must be critically assessed preoperatively, performed with proficient surgical capabilities, and given thoughtful postoperative management to reduce chances of urinary leakage, ureteral strictures, or infections. During surgical activities, the hospital facility, experience of the surgeon, and patient-related factors are some of the factors that can greatly determine the results and the total cost. Bilateral ureterostomy closure with proper patient selection, specialized surgical care, and post-surgery follow-up will be a safe and efficient measure to patients who need to normalize their urinary functions after the procedure.

Ureterostomy closure bilateral in India with GetWellGo

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• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
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FAQ

What is the duration of the surgery?

• 3-5 hours, usually, according to the complexity, number of adhesions, and the need of other surgeries (such as the creation of a neobladder)

How long is the hospital admission and recovery period?

• Hospital stay: 7–10 days.
• Full recovery: 4–6 weeks.
• The use of temporary urinary catheters and drains can be made postoperative.

Will I have to undergo other surgeries in future?

• Most of the patients do not need any additional surgery provided they are cured. Nevertheless, such complications as strictures, leaks, or obstruction can involve intervention.

What are the benefits of this surgery to life quality?

• Removes the use of external urine bags
• Limit infection and skin irritation
• Reinstates normal urinary functioning and body image
• Allows more independence in day to day tasks