Anterior transposition of ureter

Anterior Transposition of the Ureter is a surgical procedure used to reposition the ureter (the tube that carries urine from the kidney to the bladder) to bypass obstructions or prevent compression caused by external factors. This treatment is often employed in cases where the ureter is being compressed, typically by vascular structures such as the aberrant renal artery, or when the ureter needs to be rerouted to avoid other anatomical abnormalities.

Indications

Anterior transposition of the ureter is indicated for:

1. Ureteropelvic Junction Obstruction (UPJO):
   • When caused by extrinsic compression, such as by an aberrant renal artery or vein.
2. Retroperitoneal Fibrosis:
   • Compression of the ureter due to fibrotic tissue.
3. Tumors or Masses:
   • When the ureter is compressed by an adjacent tumor or mass.
4. Trauma:
   • To restore the ureter’s function after injury or surgical intervention.
5. Anatomical Abnormalities:
   • To reposition a malpositioned ureter that causes functional or structural issues.

Preoperative Preparation

1. Diagnostic Workup:

   • Imaging:
     • CT or MRI to identify the cause and location of the obstruction.
     • Intravenous pyelogram (IVP) or retrograde pyelography to evaluate the ureter.
   • Urodynamic Studies: To assess urine flow and determine the impact of obstruction.
   • Blood and Urine Tests: To evaluate kidney function and rule out infections.

2. Patient Counseling:

   • Explanation of the procedure, including risks, benefits, and alternatives.

3. Anesthesia:

   • General anesthesia is administered during the surgery.

Surgical Procedure

1. Positioning:

   • The patient is positioned based on the surgical approach (e.g., supine or lateral).

2. Access:

   • The procedure is typically performed laparoscopically or via open surgery, depending on the complexity.

3. Ureter Dissection:

   • The affected portion of the ureter is carefully dissected and mobilized from surrounding tissues.

4. Transposition:

   • The ureter is repositioned anteriorly (in front of the obstructing structure, such as a blood vessel) to relieve the compression.

5. Fixation:

   • The ureter is secured in its new position to prevent kinking or re-obstruction.

6. Stent Placement:

   • A double-J ureteral stent is often inserted to support the ureter and promote healing during the postoperative period.

7. Closure:

   • The surgical area is inspected for bleeding or leaks, and the incisions are closed.

Postoperative Care

1. Monitoring:

   • Observation of kidney function, urine output, and signs of complications (e.g., infection or obstruction).

2. Stent Management:

   • The stent is typically left in place for 4-6 weeks to ensure proper healing.

3. Pain Management:

   • Analgesics are prescribed to control postoperative pain.

4. Activity Restrictions:

   • Avoid heavy lifting, strenuous activities, and bending for 4-6 weeks.

Benefits

• Restores unobstructed urine flow from the kidney to the bladder.
• Prevents further kidney damage due to chronic obstruction.
• Relieves symptoms such as flank pain and recurrent infections.