Ureteral Reimplantation Surgery

The ureters are the tubes that carry urine from the kidneys to the bladder. The connection where one or both of your child's ureters attach to the bladder isn't fully developed. This can cause urine to flow from the bladder back up into the kidney. This is called vesicoureteral reflux (VUR). VUR doesn't cause pain. But it can increase your child's risk for urinary tract infections (UTIs). Over time, it can also damage your child's kidneys.

With ureteral reimplantation surgery, one or both ureters are moved. This makes their connection to the bladder stronger. It also helps the urine drain well and not flow backwards.

Prepare your child for the surgery as told. Also be sure to:

• Tell the doctor about any medicines your child takes. Your child may need to stop taking some or all of them before surgery, as directed by the doctor.
• Follow any directions your child is given for not eating or drinking before surgery.

The surgery takes about 2 to 3 hours. Your child will stay in the hospital for 1 to 2 days after surgery.

• An I.V. (intravenous) line is placed in a vein in your child's arm or hand. This line supplies fluids and medicines (such as antibiotics).
• To keep your child from feeling pain during the surgery, general anesthesia is given. This medicine lets your child sleep through the surgery. A tube may be put into your child's throat to help with breathing.
• A thin tube (catheter) may be placed into your child's bladder to drain urine.

• The surgery is done as an open surgery, as a robotic-assisted laparoscopy, or through an endoscope. The end of the ureter and some muscle near it are detached from the bladder.
• The surgeon will decide where in the bladder to reimplant the ureter. A tunnel is then made for the ureter to be placed inside.
• The ureter is moved to the new site in the bladder and put into the tunnel.
• Once the ureter is in place, it is secured with stitches.
• If the other ureter is also being treated, it's done at this time.
• The bladder is stitched closed.
• Any skin incisions made in the belly are closed with stitches or surgical tape.
• A small tube (drain) is placed near the incision. This drain removes fluid that can build up after the surgery.

After the surgery, your child will be taken to a recovery room. There your child will be watched as the anesthesia wears off. At first, they may feel sleepy, nauseated, and have a sore throat (if a breathing tube was used). If needed, medicine will be given to manage pain. When your child is ready, they will be moved to a hospital room.

The urinary catheter will be removed before your child leaves the hospital. The drain may also be removed. If the child is sent home with the drain, you will be shown how to care for it at home.

Follow the doctor's instructions for how to care for your child at home. Be sure to:

• Give your child medicine as directed.
• Care for your child's incision and drain as instructed.
• Follow the doctor's guidelines for bathing your child.
• Don't let your child be active until the doctor says it's okay.
• Ask the doctor when your child can return to day care or school.

Call your child's doctor right away if your child has:

• A fever of 100.4°F (38°C) or higher, or as advised by the doctor.
• Symptoms of infection at an incision site (such as increased redness or swelling, warmth, worsening pain, or bad-smelling drainage).
• Problems with the drain.
• Severe vomiting.
• Dark blood or clots in the urine (some pink-tinged urine is normal).
• Problems with being able to urinate.
• Crying that can't be calmed or refuses to feed (infants).

Call 911 right away if your child has:

• Chest pain.
• Trouble breathing.

At follow-up visits, the doctor will check how well your child is healing. If needed, your child's stitches and drain will be removed in about 7 days. Tests may be done 1 to 3 months after the procedure. These may include a kidney ultrasound. These tests let the doctor check that your child's urinary tract is working correctly.

All procedures have some risk. Possible risks for this surgery include:

• Bleeding (your child may need a blood transfusion).
• Infection.
• Pain.
• Urine leakage from the ureters.
• The stricture of ureters comes back.
• Damage to the bladder, bowels, or other organs.
• Kidney damage.
• Risks of anesthesia (the anesthesiologist or nurse anesthetist will discuss these with you).