Ureteroneocystostomy

Ureteroneocystostomy is a surgical procedure to reimplant the ureter into the bladder. It is commonly performed to address ureteral obstruction, injury, or vesicoureteral reflux (VUR). The procedure restores normal urine flow from the kidney to the bladder while preventing backflow or leakage.

Indications

Ureteroneocystostomy is indicated for:

1. Ureteral Obstruction:
   • Due to ureteral stricture, congenital anomalies, or external compression.
2. Ureteral Injury:
   • Following trauma, previous surgery, or radiation therapy.
3. Vesicoureteral Reflux (VUR):
   • Retrograde urine flow from the bladder to the kidneys.
4. Ureteral Endometriosis:
   • Compression or invasion of the ureter by endometrial tissue.
5. Ureteral Tumors:
   • Benign or malignant lesions requiring partial ureter removal.
6. Iatrogenic Causes:
   • Injury during gynecologic, urologic, or colorectal procedures.

Types of Ureteroneocystostomy

1. Direct Reimplantation:

   • Ureter is directly inserted into the bladder without tunneling.
   • Suitable for distal ureteral conditions with minimal tension.

2. Tunneled Reimplantation (Anti-Reflux Technique):

   • Ureter is implanted into the bladder through a submucosal tunnel.
   • Common in cases of vesicoureteral reflux or recurrent urinary infections.

3. Psoas Hitch Procedure:

   • The bladder is mobilized and sutured to the psoas muscle to bridge the gap.
   • Used when a significant length of the ureter is missing.

4. Boari Flap:

   • A bladder flap is used to create a new ureteral segment.
   • Suitable for longer ureteral defects.

Preoperative Preparation

1. Diagnostic Workup:

   • Imaging: Ultrasound, CT Urogram, or MRI to assess the ureter and bladder anatomy.
   • Cystoscopy: Direct visualization of the bladder and ureteral orifices.
   • Renal Function Tests: To evaluate kidney health.
   • Urinalysis: To rule out infections before surgery.

2. Patient Counseling:

   • Explain the goals, risks, and benefits of the procedure.
   • Discuss potential postoperative outcomes and recovery.

3. Anesthesia:

   • General anesthesia is used for the procedure.

Surgical Procedure

1. Incision and Exposure:

   • Performed via open, laparoscopic, or robotic-assisted approaches.
   • The bladder and affected ureter are accessed through the abdominal cavity.

2. Ureter Mobilization:

   • The diseased or damaged segment of the ureter is excised.
   • The healthy ureter is mobilized for reimplantation.

3. Bladder Incision and Ureteral Reimplantation:

   • A small incision is made in the bladder wall.
   • The ureter is implanted into the bladder using an anti-reflux technique or directly.

4. Stent Placement:

   • A double-J stent is inserted to ensure ureteral patency and support healing.

5. Closure:

   • The bladder incision is closed with absorbable sutures.
   • The surgical area is inspected for leaks.

Postoperative Care

1. Hospital Stay:

   • 2-5 days, depending on the complexity of the surgery.

2. Pain Management:

   • Administer analgesics and anti-inflammatory medications.

3. Fluid Intake:

   • Encourage hydration to ensure proper urine flow.

4. Catheter and Stent Care:

   • A Foley catheter is typically left in place for 5-10 days.
   • The stent is usually removed 4-6 weeks after surgery.

5. Antibiotics:

   • Prescribed to prevent postoperative urinary infections.

6. Activity Restrictions:

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

Benefits

• Resolves ureteral obstruction and restores urine flow.
• Prevents urinary infections and kidney damage.
• Corrects vesicoureteral reflux and improves bladder function.

Risks and Com