Ureteroneocystostomy is a surgical procedure that re-establishes the connection between a ureter and the bladder. The general purpose of this specialized procedure is to restore the normal flow of urine from the kidney to the bladder, while also preventing any backward flow or leakage.
What Ureteroneocystostomy Involves
The human urinary system includes the kidneys, ureters, bladder, and urethra. The kidneys filter waste from the blood to produce urine, which then travels down two tubes called ureters. These ureters, typically 25 to 30 centimeters long in adults, transport urine from each kidney to the bladder. The bladder, a muscular sac, stores urine until it is expelled from the body through the urethra.
Ureteroneocystostomy specifically addresses issues at the junction where the ureter meets the bladder. The procedure involves reimplanting one or both ureters into a new or modified position within the bladder wall. This surgical adjustment aims to ensure that urine flows efficiently from the kidney into the bladder without refluxing, which can lead to complications. The success of the procedure often relies on creating a non-refluxing connection to protect kidney health.
Why the Surgery is Performed
Ureteroneocystostomy is performed to correct various conditions that disrupt the normal flow of urine from the kidneys to the bladder. One common reason is vesicoureteral reflux (VUR), where urine flows backward from the bladder into the ureters and sometimes up to the kidneys, potentially causing recurrent urinary tract infections and kidney damage. In children, VUR is a frequent indication for this surgery.
The procedure also addresses ureteral strictures, which are narrowings of the ureter that can obstruct urine flow. These can result from congenital anomalies, external compression, trauma, previous surgeries, radiation therapy, endometriosis, or tumors. The surgery is also performed to repair ureteral injuries, particularly those affecting the distal 3-5 centimeters of the ureter, which might occur during gynecologic, urologic, or colorectal procedures. It is also a common procedure during kidney transplantation to connect the donor ureter to the recipient’s bladder.
How the Surgery is Done
Ureteroneocystostomy can be performed using several surgical approaches, including traditional open surgery, laparoscopic surgery, and robotic-assisted surgery. The choice of technique often depends on the specific condition being treated, the length of the ureteral defect, and the surgeon’s preference and experience. Regardless of the approach, the general principle involves detaching the affected ureter from its original bladder connection.
In open surgery, a larger incision is made in the lower abdomen to directly access the ureter and bladder. Laparoscopic surgery involves several small incisions through which thin instruments and a camera are inserted. Robotic-assisted surgery is a variation of laparoscopy, utilizing a robotic system controlled by the surgeon to enhance precision and maneuverability.
Once the ureter is detached, a new passage or tunnel is created within the bladder wall. The healthy end of the ureter is then reattached into this new opening, often with a technique that creates a flap valve mechanism to prevent urine from flowing backward.
For longer ureteral defects, modifications like the psoas hitch or Boari flap may be employed. A psoas hitch involves mobilizing the bladder and suturing it to the psoas muscle to bridge a gap when a significant portion of the ureter is missing. A Boari flap uses a section of the bladder wall, which is reshaped into a tube, to create a new segment of the ureter, allowing for the repair of more extensive defects. A temporary ureteral stent is often placed in the ureter after the procedure to ensure proper healing and urine flow, typically removed after a few weeks.
Life After Ureteroneocystostomy
Following ureteroneocystostomy, patients typically remain in the hospital for approximately 1 to 5 days, with minimally invasive approaches often leading to shorter stays compared to open surgery. Pain management is an important aspect of recovery and usually involves a combination of over-the-counter pain relievers and, if necessary, prescribed narcotics. Patients are generally encouraged to start walking early to aid recovery and prevent complications like blood clots or lung issues.
Activity restrictions after surgery usually include avoiding heavy lifting and strenuous activities for several weeks to allow the surgical site to heal. A urinary catheter is often placed during surgery and may remain for a few days to a couple of weeks to facilitate healing. In some cases, a surgical drain may be left in place to remove excess fluid from the surgical area, which is typically removed before discharge.
Potential short-term complications can include urinary tract infections, bladder spasms, hematuria (blood in urine), or urine leakage (extravasation) from the surgical site. Long-term considerations include persistent vesicoureteral reflux, recurrent stricture formation at the re-implant site, or bladder dysfunction. Regular follow-up appointments with the surgeon are important to monitor healing, assess kidney function, and address any potential complications, often including imaging tests like renal ultrasonography approximately three months post-operatively.