• Laparoscopic Ureteral Reimplantation

    (Laparoscopic Ureterectomy with Reimplantation)

    Definition

    Laparoscopic ureteral reimplantation is surgery to reposition a ureter. The ureter is a tube between the kidney and the bladder. It allows urine to pass down to the bladder.
    Laparoscopic procedures use small incisions and specialized tools. This helps to avoid large incisions that are needed with open surgery.
    The Urinary Tract
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Some ureters are not positioned correctly in the bladder. This can make it difficult for urine to flow into the bladder. Ureteral reimplantation may be done to reposition ureters that:
    • Are causing urine to flow back into the ureters and kidneys—known as vesicoureteral reflux (VUR)
    • Were damaged due to trauma or surgery

    Possible Complications

    If you are having this procedure, the doctor will review a list of possible complications. Possible complications with any surgery include:
    • Excess bleeding
    • Adverse reaction to anesthesia, including, light-headedness, low blood pressure, and wheezing
    • Infection
    • Soreness in throat
    • Nausea and vomiting
    Possible complications due to ureteral reimplantation include:
    • Bladder spasms
    • Cramping
    • Difficulty urinating
    Talk to the doctor about these risks before the procedure.

    What to Expect

    Prior to Procedure

    • The doctor may need pictures of your urinary tract.
    • Blood and urine tests may be done. Theses test will show how well the kidneys are working.
    • Talk to the doctor about any medicines you are taking:
      • Do not take any new medicines, herbs, or supplements without talking to the doctor.
      • You may be asked to stop taking some medicines up to one week before the procedure, like anti-inflammatory drugs, blood thinners, and anti-platelet drugs.
    • Arrange for a ride home from the hospital.
    • The night before surgery, you should eat a light meal. You should not eat or drink anything after midnight unless told otherwise by the doctor.

    Anesthesia

    General anesthesia may be used. It will be given through a vein in the arm or hand. You will be asleep through the procedure.
    A spinal block may be used. This is an anesthesia injected into the spine. It will block pain below your waist.

    Description of the Procedure

    A few small incisions will be made in your abdomen. Specialized tools will be inserted through the incisions. A series of incisions and stitches will be used to realign the ureter. The doctor will choose a method based on your specific condition.
    Once the tools are removed the incisions in the abdomen will be closed with stitches. Bandages may be placed over the incisions.

    Immediately After Procedure

    After the operation, you will be taken to the recovery room for observation. If all is well, the breathing tube will likely be removed.

    How Long Will It Take?

    Two to three hours

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. There may be some pain as you recover. You may also have some cramping in your bladder. The doctor will give you medication to help manage any discomfort.

    Average Hospital Stay

    The usual length of stay is two days. You may need to stay longer if there are complications.

    Post-procedure Care

    At the Hospital
    • You will receive fluids and medicines through an IV.
    • Urine will drain through the tube into a bag. The urine may have blood in it for the first few days.
    At Home
    When you return home, take these steps:
    • Drink plenty of fluids.
    • Follow the doctor’s instructions on cleaning the incision site.
    • Ask the doctor about when it is safe for you to shower, bathe, or soak in water.
    • Ask the doctor when you can resume normal activities.
    Be sure to follow the doctor’s instructions.

    Call Your Doctor

    Call your doctor if any of these occur:
    • Difficulty urinating
    • Excess bleeding
    • Signs of infection, including fever and chills
    • Pus or bad smelling fluids draining from the incision site
    • Redness or swelling at the incision site
    • Urine that smells bad
    • Pain that cannot be controlled with the medicines the doctor prescribed
    • Nausea and/or vomiting that you cannot control with the medicines the doctor prescribed
    If you think you are having an emergency, call for medical help right away.

    RESOURCES

    American Academy of Pediatrics http://www.healthychildren.org

    American Urological Association http://www.auanet.org

    National Kidney and Urologic Diseases Information Clearinghouse http://www.kidney.niddk.nih.gov

    CANADIAN RESOURCES

    Canadian Paediatric Society http://www.cps.ca

    Canadian Urological Association http://www.cua.org

    Health Canada http://www.hc-sc.gc.ca

    References

    Smith A. Smith’s Textbook of Endourology . 2nd ed. Hamilton, ON: BC Decker Inc.; 2007:834.

    Ureteral reimplant surgery FAQ. UCSF Benioff Children’s Hospital website. Available at: http://www.ucsfbenioffchildrens.org/education/ureteral%5Freimplant%5Fsurgery/index.html . Accessed January 17, 2013.

    Ureteral reimplant. Children’s Hospitals and Clinics of Minnesota website. Available at: http://www.childrensmn.org/manuals/pfs/surg/018768.pdf . Accessed January 17, 2013.

    Ureteral reimplantation. Children’s Hospital of Wisconsin website. Available at: http://www.chw.org/display/PPF/DocID/48560/router.asp . Accessed January 17, 2013.

    Ureteral reimplantation surgery. Children’s Hospital of Pittsburgh website. Available at: http://www.chp.edu/CHP/Ureteral+Reimplantation+Surgery . Accessed January 17, 2013.

    Vesicoureteral reflux. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated April 26, 2012. Accessed January 17, 2013.

    Vesicoureteral reflux. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/vesicoureteralreflux/#how . Updated June 29, 2012. Accessed January 17, 2013.

    Revision Information

    • Reviewer:
    • Review Date: 06/2013
    • Update Date: 06/24/2013
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