Major Ureter Reconstruction

A ureter is a tube that allows urine to travel from the kidney to the bladder. Each ureter is around 8 to 10 inches long, and it is surrounded by the muscle that tightens and relaxes to force urine down into the bladder, away from the kidneys.

A ureter can get injured during any type of pelvic surgery, which includes

• During gynecological surgery,
• Colorectal surgery,
• Injury during pelvic surgery,
• Hysterectomy,
• Radiation,
• Endoscopic stone procedures,
• Cancers of the urinary tract or retroperitoneal fibrosis,
• Injuries may also happen due to a large-sized rectal or sigmoid colon cancer, the normal ureter anatomy might be distorted, this distorted anatomy can place the ureter in an abnormal place.
• If a tumor involves the ureter, then a segment of the ureter is removed to remove all cancer.
• It might have happened during endoscopic surgery for kidney stones, particularly if the stone is large or stuck to the wall. The injured ureter may get scarred and prevent urine from draining from the kidney. Such scar tissue of the ureter needs surgical reconstruction.

There are many surgical approaches to ureter repair and management. That can vary from simple outpatient procedures that require camera approaches with minimal recovery to major abdominal repairs to needs a long hospitalization and also a long duration to recover.

Every repair is based on several factors that include - the location of the injury, length of the injury, mechanism of the injury and complicating factors, and any other medical conditions that affect the situation. Potential complications of the surgery include recurrence of UTI, urinary tract blockage, obstruction, bleeding, kidney stones, kidney deterioration, blood clots, and urine leak.

Methods:

• Ureter reimplants
• Psoas hitch surgery
• Boari flap surgery
• Ureter patch or interposition with the appendix
• Ileal ureter
• End-to-end repair

The side effect of Psos hitch surgery-

• By freeing up and stretching the bladder you may feel a little unstable, causing frequent urination.
• injury of the genito-femoral nerve. This happens very rarely and only when the ureter is stuck to the nerve. The consequence of this injury is numbness of the anterior thigh skin. It resolves with time.

Side effects of Boari flap surgery-

• sometimes, the bladder becomes unstable that causes frequent urination.
• It will take a long time for the bladder to stretch up till normal.

The patient should not do any driving until the catheter is removed.

The patient should not do any kind of lifting or strenuous activity for one to two months.

Yes, many patients need an internal stent which usually stays for about four weeks after the surgery and is removed by the doctor during the follow-up visit.