The procedure reconnects the ureter to the bladder, correcting anomalies in the urinary tract. Find out when it is indicated and how it can benefit urological health.
Ureteral reimplantation is a surgical procedure involving the replacement or reconnection of the ureters, channels that exit the kidney towards the bladder, correcting abnormalities or damage to the ureters.
This surgery is indicated to treat a variety of medical conditions related to the ureters, in specific cases where there is obstruction, vesicoureteral refluxtraumatic injuries or congenital anomalies that compromise kidney function and the patient's health, for example.
Let's explore more about what ureteral reimplantation is and its indications. Read on and check it out.
What is ureteral reimplantation?
Ureteral reimplantation is a surgical intervention that aims to correct anomalies or dysfunctions of the ureters, re-establishing their proper connection with the bladder.
This procedure is performed to restore normal urine flow and prevent serious complications such as recurrent urinary infections, kidney failure and damage to the organs involved.
When is ureteral reimplantation indicated?
According to Dr. Ubirajara Barroso Jr., head of the division of reconstructive urological surgery and pediatric urology at the Federal University of Bahia Hospital, ureteral reimplantation consists of reconnecting the ureter to the bladder, creating a valve that prevents the backflow of urine.
He points out that this procedure is especially indicated in cases of high-grade vesicoureteral reflux, in which urine returns from the bladder to the kidney, or in situations of obstruction at the junction of the ureter and bladder, which can cause dilation of the ureter and kidney, increasing the risk of loss of kidney function.
Dr. Barroso Jr. lists some indications for ureteral reimplantation:
Vesicoureteral reflux:
This is a condition in which urine flows back from the ureters to the kidneys, instead of following its normal course to the bladder. "Reimplantation of the ureter, in the case of versicoureteral reflux, is indicated mainly when there is repeated urinary infection, essentially when this infection reaches the kidneys, which can cause increased renal scarring and irreversible damage," explains Dr. Ubirajara Barroso Jr., who is also head of the Urinary System Unit at the Professor Edgard Santos University Hospital (UFBA).
Ureteral stenosis:
When the ureter becomes narrowed due to scarring, inflammation or other factors, a partial or complete blockage of urine flow can occur. "If it is documented, whether congenital or acquired, for example, caused by the passage of stones or surgery, ureteral reimplantation is also indicated," he says.
Ureteral obstruction:
In cases of severe obstruction of the ureter due to kidney stones, tumors or other causes, ureteral reimplantation may be necessary to unblock the ureter and restore kidney function.
Traumatic injuries:
Severe trauma or injury to the urinary tract may require ureteral reimplantation to repair damage to the ureters and restore continuity to the urinary system.
Congenital anomalies:
Some congenital conditions, such as duplex ureter syndrome or ureterocele, may require ureteral reimplantation to correct abnormalities in the ureters.
Dr. Ubirajara Barroso Jr. explains that ureteral stenosis can be congenital or acquired.
The most common congenital stenoses are:
- Primary megaureter: a condition in which the ureter has an abnormally dilated diameter. This dilation can occur in a specific part of the ureter or along its entire length;
- Ureterocele: is a condition in which the end of the ureter dilates abnormally, forming a pouch or sac in the bladder;
- Ectopic ureter: in this condition, the ureter does not connect to the proper location in the bladder and instead inserts itself in an abnormal position elsewhere in the urinary tract or in adjacent organs.
On the other hand, acquired stenoses can arise due to:
- Passage of stones that injure the distal portion of the ureter;
- Ureteral tuberculosis;
- Iatrogenic injuries. "These result from medical procedures, such as stone extraction, uterine removal surgery or treatment of pelvic tumors," he describes.
- External trauma, such as stab wounds or gunshot wounds, can also lead to acquired ureteral strictures.
What is the diagnosis for ureteral reimplantation?
"The diagnosis is made using a test called voiding cystourethrography, which involves passing a probe through the urethra and injecting contrast into the bladder. This contrast is not absorbed like venous contrasts and radiological images are obtained to check if the reflux reaches the kidneys," says Dr. Ubirajara Barroso.
How is ureteral reimplantation surgery performed?
According to Dr. Barroso Jr., the ureteral reimplantation procedure can be performed by open surgery, laparoscopic surgery and robotic surgery.
"The purpose of ureter reimplantation surgery is to reattach the ureter to the bladder, making a ureterovesical tunnel, so the ureter slides between the mucosa and the muscle, making a valve that will prevent urine from returning to the kidneys," he says.
During the procedure, the ureter is carefully realigned and sutured to the bladder, ensuring a normal flow of urine from the kidney to the bladder.
What is the pre- and post-operative care for ureteral reimplantation surgery?
Ureteral reimplantation surgery can be performed outside the bladder or inside the bladder. According to Dr. Ubirajara Barroso Jr., who also works as a urologist in São Paulo, ureteral reimplantation is a highly successful procedure, with a significant success rate of between 95% and 97%.
"When it's done outside the bladder, it's called extravesical. It is a procedure that causes less discomfort, and probing can be carried out for a few hours or a day, but in ureteral reimplants where it is necessary to open the bladder, probing is usually carried out for three to five days and when the probe is removed, the patient starts to urinate normally without any major complications," says the urologist.
According to the specialist, the main complications associated with this procedure include the return of vesicoureteral reflux or restenosis of the ureter.
If you or someone you know is experiencing serious urinary problems, make an appointment for proper evaluation and guidance on the treatment options available, including ureteral reimplantation. Dr. Ubirajara Barroso Jr. is based in Salvador (BA) and São Paulo (SP).
SEE ALSO: Endoscopic injection for the treatment of Vesicoureteral Reflux