Our Summary

This research paper discusses a surgical procedure used to repair the ureter, a tube that carries urine from the kidneys to the bladder. This procedure, known as ureteral reimplantation, is recommended for patients with certain conditions like a narrowing of the ureter, injuries to the ureter caused during surgery, or those who need a section of the ureter removed due to a type of cancer.

The researchers used the da Vinci system, a robotic surgical system, to perform the ureterectomy (removal of the ureter) and reimplantation. They demonstrated two types of reimplantations - one that allows urine to flow back into the kidney and one that doesn’t. They also showed some modifications to the procedure, including the psoas hitch and Boari flap, which are techniques used to help connect the ureter to the bladder.

The study found that it’s possible to consistently perform this operation with the help of robotic systems. They also discussed how to differentiate between healthy and diseased ureter, the use of a specific dye to help visualize the ureter during surgery, and the use of a stent (a small tube) to keep the ureter open during healing.

In conclusion, the researchers found that robotic ureteral reimplantation is a safe and feasible procedure when performed correctly. The use of a scope to view the ureter and a special type of light technology can help surgeons better detect diseased sections of the ureter. The key to a successful operation is to ensure the connection between the ureter and bladder is secure, leak-proof, and free of tension.

FAQs

  1. What is ureteral reimplantation and when is it indicated?
  2. What is the role of the da Vinci system in ureteral reimplantation?
  3. How does robotic ureteral reimplantation improve the detection of diseased ureteral segments?

Doctor’s Tip

One helpful tip a doctor might tell a patient about ureteral reimplantation is to follow postoperative care instructions carefully, including taking prescribed medications, avoiding heavy lifting or strenuous activities, and keeping the incision site clean and dry to prevent infection. It is also important to attend all follow-up appointments to monitor healing and address any concerns or complications that may arise.

Suitable For

Patients who are typically recommended for ureteral reimplantation include those with congenital distal ureteral strictures, iatrogenic intraoperative distal ureteral injuries, and those who require distal ureterectomy for transitional cell carcinoma. Additional factors that may warrant ureteral reimplantation include the presence of diseased ureteral segments, the need for a tension-free and watertight anastomosis, and the use of interoperative ureteral stents. Robotic ureteral reimplantation with techniques such as psoas hitch and Boari flap can be safe and feasible when performed with proper technique.

Timeline

Before ureteral reimplantation, a patient may experience symptoms such as recurrent urinary tract infections, flank pain, hematuria, and hydronephrosis. They may undergo various diagnostic tests such as imaging studies, cystoscopy, and ureteroscopy to determine the underlying cause of their symptoms. Once a decision is made to proceed with ureteral reimplantation, the patient will undergo preoperative preparation including medical evaluations and consent for surgery.

During the surgery, the patient is placed under general anesthesia and the robotic-assisted procedure is performed. The diseased portion of the ureter is removed, and the healthy ureter is reimplanted either in a refluxing extravesical or nonrefluxing extravesical manner. Modifications such as psoas hitch and Boari flap may be used depending on the specific case.

After the surgery, the patient will typically stay in the hospital for a few days for monitoring and pain management. They will be discharged with instructions for postoperative care, including taking prescribed medications, monitoring for any signs of infection or complications, and following up with their healthcare provider for follow-up appointments. The patient may experience some discomfort and urinary symptoms in the immediate postoperative period, but these should improve over time as they recover from the surgery.

What to Ask Your Doctor

  1. What is the reason for recommending ureteral reimplantation in my case?
  2. What are the potential risks and complications associated with ureteral reimplantation?
  3. What are the different techniques available for ureteral reimplantation, and which one would be most suitable for me?
  4. How long is the recovery period after ureteral reimplantation surgery?
  5. Will I need to have a catheter or stent placed after the procedure, and for how long?
  6. How will ureteral reimplantation affect my overall kidney function?
  7. Are there any lifestyle changes or restrictions I need to follow after the surgery?
  8. What follow-up appointments will I need after the procedure?
  9. What are the success rates of ureteral reimplantation in cases similar to mine?
  10. Are there any alternative treatment options to consider before proceeding with ureteral reimplantation?

Reference

Authors: White C, Stifelman M. Journal: J Endourol. 2020 May;34(S1):S25-S30. doi: 10.1089/end.2018.0750. PMID: 32459151