Our Summary

The laparoscopic ureteral reimplantation (LUR) is a surgical procedure used to treat injuries in the ureter, a tube that carries urine from the kidneys to the bladder. This technique has been used for over 20 years, but there is limited research about it because most studies have been small and have not provided consistent results. However, the available research suggests that LUR is a safe and effective technique. It appears to have fewer complications and better safety compared to the traditional open surgery.

While there isn’t strong evidence supporting the benefits of using anti-reflux techniques (procedures that prevent urine from flowing back into the kidneys) during LUR in adults, many surgeons tend to include these procedures. The main reason doctors use LUR is to treat ureteral injuries that occur below the iliac vessels (major blood vessels in the pelvis).

Most of these injuries are discovered shortly after surgery. While traditional advice often recommends urinary diversion (rerouting the flow of urine) and delayed treatment, immediate treatment using LUR is possible and seems to lead to better results in terms of fewer complications, shorter hospital stays, and better long-term kidney function.

In cases where a patient develops peritonitis (inflammation of the abdominal lining) after surgery due to a ureteral fistula (an abnormal connection between the ureter and another part of the body), immediate LUR may provide specific advantages, including potentially helping to protect against abdominal sepsis (a serious infection that spreads throughout the body).

FAQs

  1. What is laparoscopic ureteral reimplantation and how long has it been used as a procedure?
  2. How does the success rate of laparoscopic ureteral reimplantation compare to open ureteral reimplantation?
  3. What is the main indication for ureteral reimplantation and when is it typically diagnosed?

Doctor’s Tip

A doctor may advise a patient undergoing ureteral reimplantation to follow post-operative care instructions carefully, including taking prescribed medications as directed, avoiding strenuous activities, and attending follow-up appointments. They may also recommend maintaining good hydration and avoiding activities that could put stress on the surgical site to promote proper healing. Additionally, the doctor may advise the patient to monitor for any signs of infection or complications, such as fever, increased pain, or changes in urinary output, and to seek medical attention if any concerns arise.

Suitable For

Patients who are typically recommended ureteral reimplantation include those with ureteral injuries below the iliac vessels, postoperative peritonitis secondary to a ureteral fistula, and those who have been diagnosed with ureteral injuries in the early postoperative period. Additionally, patients who may benefit from anti-reflux reimplantation techniques, although evidence of their benefits in adults is limited, are also recommended for ureteral reimplantation. Immediate LUR is especially beneficial in situations where intraoperative recognition of the injury is possible, as it can prevent further complications and improve long-term outcomes.

Timeline

Before ureteral reimplantation:

  • Patients may experience symptoms such as flank pain, urinary tract infections, hematuria, and urinary leakage
  • Diagnostic tests such as imaging studies (CT scan, MRI, ultrasound) and cystoscopy may be performed to identify the underlying cause of the symptoms
  • Treatment may involve urinary catheterization, antibiotics, or stenting to relieve symptoms and prevent further complications

After ureteral reimplantation:

  • Patients typically undergo a period of postoperative recovery, which may include pain management, monitoring for complications, and follow-up appointments with the surgeon
  • Patients may experience temporary urinary incontinence, frequency, or urgency as the bladder and ureters heal
  • Long-term follow-up may involve imaging studies and urine tests to monitor the success of the reimplantation and ensure that the ureter is functioning properly
  • Overall, ureteral reimplantation has been shown to be a safe and effective procedure for treating ureteral injuries and improving long-term renal function.

What to Ask Your Doctor

Some questions a patient should ask their doctor about ureteral reimplantation may include:

  1. What are the potential risks and complications associated with ureteral reimplantation?
  2. What is the success rate of ureteral reimplantation compared to other treatment options?
  3. Will I need to undergo any additional tests or procedures before the surgery?
  4. How long is the recovery period after ureteral reimplantation?
  5. Will I need to make any lifestyle changes or follow a specific diet after the surgery?
  6. How will my kidney function be monitored after the procedure?
  7. What can I expect in terms of pain management during the recovery process?
  8. Are there any specific warning signs or symptoms I should watch for after the surgery?
  9. How often will I need to follow up with you after the procedure?
  10. Are there any long-term implications or considerations I should be aware of following ureteral reimplantation?

Reference

Authors: González Rodríguez I, Gil Ugarteburu R, Fernández-Pello S, Díaz Méndez B, Blanco Fernández R, Mosquera Madera J. Journal: Arch Esp Urol. 2017 May;70(4):412-421. PMID: 28530620