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URETERIC REIMPLANT (URETERONEOCYSTOSTOMY)
What is a ureteric reimplant?
Ureteric reimplantation, also known as ureteral reimplantation or ureteroneocystostomy, is a surgical procedure performed to correct a condition called vesicoureteral reflux (VUR). VUR is a medical condition where urine flows backwards from the bladder into the ureters and sometimes up to the kidneys, increasing the risk of urinary tract infections and potential kidney damage.
When is a ureteric reimplant indicated?
Ureteric reimplantation is indicated in the following situations:
- Vesicoureteral reflux (VUR): Ureteric reimplantation is primarily performed to treat VUR, a condition where urine flows backwards from the bladder into the ureters and potentially up to the kidneys. The severity of VUR and the presence of associated complications guide the decision for surgical intervention.
- High-grade VUR: Ureteric reimplantation is commonly recommended for patients with high-grade VUR (Grades III to V). High-grade reflux carries a greater risk of kidney damage and recurrent urinary tract infections (UTIs), making surgical correction necessary.
- Persistent or recurrent UTIs: If a patient experiences persistent or recurrent UTIs despite appropriate medical management, ureteric reimplantation may be considered. The surgery aims to prevent the backflow of urine and reduce the risk of UTIs.
- Renal scarring or kidney damage: VUR can lead to kidney damage, including renal scarring or hydronephrosis (enlargement of the kidney due to urine buildup). If kidney damage is present or progressing, ureteric reimplantation may be indicated to protect kidney function and prevent further complications.
- Failed conservative treatment: Conservative management options for VUR, such as antibiotic prophylaxis and bladder training, may be insufficient to control reflux or prevent complications. If conservative measures fail, ureteric reimplantation may be necessary.
- Symptomatic VUR: VUR can cause symptoms such as recurrent urinary tract infections, urinary incontinence, and urinary urgency. When VUR is symptomatic and negatively impacts a patient's quality of life, ureteric reimplantation may be considered.
How is ureteric reimplantation performed?
During the procedure, a surgical incision is made in the lower abdomen above the pubic bone, allowing Dr Singh to detach the end of the ureter and nearby muscle from the bladder. He will determine the appropriate location in the bladder for reimplantation, creating a tunnel for the ureter to be inserted.
The urologist will carefully move the ureter to its new position within the bladder. It is placed inside the tunnel and secured with stitches. If necessary, the other ureter is also treated simultaneously. The bladder is sutured closed, and the skin incision is closed using either stitches or surgical tape. A drain may be inserted near the incision to remove fluid accumulation during the recovery process.
FAQ
What is recovery like after ureteric reimplantation?
The recovery period varies depending on the individual and the surgical approach used. In general, patients may need to stay in the hospital for a few days for monitoring and pain management. Pain medication and antibiotics are typically prescribed. Regular appointments will be necessary to observe the progress of the healing process and assess urinary functionality.
Will my infant be conscious during the pyeloplasty?
No, your infant will be administered general anaesthesia, ensuring complete unconsciousness and a pain-free experience throughout the pyeloplasty.
What is the success rate of ureteric reimplantation?
Ureteric reimplantation has a high success rate in resolving VUR and preventing further complications. The success rate depends on various factors, such as the severity of the reflux, the presence of associated kidney damage, and the expertise of the surgeon.
