Ureteral Re-Implant

A ureteral re-implant can restore normal function.

Urine normally travels from the kidneys to the bladder through tubes called ureters. If these tubes aren't positioned correctly, the normal flow of urine may be affected. More common in children and usually cognitional in nature, abnormal ureter positioning often causes urine to travel back into the kidneys (vesicoureteral reflux).

• If left untreated, the back-up of urine could lead to serious kidney problems and other issues with the urinary system.
• A surgical procedure frequently performed to restore the proper alignment of the ureters is ureteral re-implant surgery.

Signs Ureters May Not Be Positioned Correctly

The bladder is made of muscles that are normally positioned in a way that allows urine to flow from the bladder to the kidneys, but not in the reverse direction. If the ureters are improperly positioned, the bladder muscle doesn't fully cover one or both tubes, setting up a situation where urine is produced in the kidneys, transported to the bladder, and pushed back up the ureter into the kidney it's attached to. Vesicoureteral reflux symptoms suggesting the ureters may not be aligned correctly include:

• Recurring urinary tract infections without another cause
• Abdominal or side pain
• Urination in smaller amounts
• Signs of kidney problems

Diagnosis and Re-Implant Surgery

A positive diagnosis of vesicoureteral reflux due to misplaced ureter is made with tests that usually include kidney and bladder ultrasound and the injection of a dye to view the patient's bladder. A similar test is a voiding cystourethrogram (VCUG). It involves the use of an X-ray with a contrast dye to view the bladder from different positions.

Some children outgrow vesicoureteral reflux without the need for treatment. If this doesn't happen, ureter re-implant surgery is done to reposition the affected ureter so it lines up properly with the bladder muscle.

Minimally invasive techniques commonly used during re-implant surgery mean that a smaller incision can be made into the abdomen to reach the affected area. Special instruments are used to reposition the ureter during a procedure that typically takes a few hours to complete. A catheter is also inserted during surgery.

Post-Surgery Care and Pain Management

While the repositioned ureter heals, the urinary catheter will remain inserted to help with urination. Nerve block injections may ease discomfort for children immediately after surgery. Pain may also be managed with over-the-counter medications or a special type of pump that slowly delivers medication intravenously.

Urination After Ureteral Re-Implant Surgery

Children sometimes experience bladder spasms, frequent urination, cramping, and other temporary issues following surgery. Some children also have urinary incontinence, or urine leaks. Medication and the use of padded garments may help ease these inconveniences and improve comfort as the re-implanted ureter and related structures heal. A urologist should be contacted immediately if post-surgery issues involve:

• Difficulty urinating
• Fever
• Vomiting
• Changes in mood for no apparent reason
• Severe abdominal pain

Children who have ureter re-implant surgery are sometimes susceptible to urinary tract infections. While UTIs may occur prior to surgery, such infections are usually easier to treat and manage post-surgery. As a precaution, low-dose maintenance antibiotics are sometimes recommended to help fight any infections that may be present and prevent new UTIs from developing. Follow-up care often includes an ultrasound and a VCUG scan to confirm that the reflux has been resolved.