Ureteral Reimplant Surgery

What is ureteral reimplant surgery?

Ureteral reimplant (you-REE-ter-al ree-IM-plant) is a surgical procedure to fix a ureter that is not connected to the bladder in the usual place. The ureter is the tube that carries urine (pee) from the kidneys to the bladder. Sometimes, the ureter is connected to the bladder in such a way that it lets urine flow back to the kidneys. This can damage the kidneys.

Urinary System (Female)

Your child's operation is needed to prevent urine from backing up from the bladder to the kidney and damaging kidney tissue. Two different methods can be used for this operation. The urologist will discuss with you which one is best suited to your child's condition.

The day of surgery

Bring your child to the Urology or Day Surgery unit 2 hours before the time of your child's operation. During this time the following things will happen:

• your child will be admitted to the unit
• the nurse will examine your child
• your child will change into a hospital gown

A small number of children are admitted on the day before surgery. Your child's urologist will tell you if your child needs to do this.

Your child's operation is scheduled for: (date and time) _______________________________

Please bring your child to the unit at: (date and time) _________________________________

Name and location of the surgical unit doing the operation:____________________________

How long the operation takes depends on the surgery that is planned. Check with your child's nurse to find out how long the operation will probably take.

Your child will have several tubes after the operation

When your child comes back from the operating and recovery rooms, he will have some or all of the following tubes in place:

• An intravenous (IV) tube. This is a small plastic tube that goes into a vein in your child's arm. It is used to give your child fluids and medications until he can drink.
• A urinary catheter. This is a small tube that goes into your child's bladder to drain the urine. The type of catheter your child has depends on the type of surgery. A urethral catheter goes into the bladder through the urethra, the tube that takes urine from the bladder to the outside of the body. A supra-pubic catheter goes into the bladder through a tiny opening in your child's abdomen (belly).
• A drain. This is a small rubber tube that is placed in your child's belly to drain out extra fluid that may have collected during surgery.
• A stent. This is a tube that drains the urine from the ureter above the place where the surgery was performed. The stent will come out through a small opening in the belly.
• An internal stent. This is a small tube that might be left inside the body and removed 6 weeks after the operation. It helps drain the urine from the kidney to the bladder. This helps the area where the surgery was done to heal.

Ask your doctor what types of draining tubes your child will probably need, so that you know what to expect after the operation. The doctor or nurse can explain how long your child will need each tube.

Returning to normal after the operation

Eating and drinking

Most likely, your child will not be allowed to eat or drink anything until the morning after the operation. At this time, your nurse will explain how to start slowly with fluids. Your child can gradually eat and drink more until he is back to what he normally eats and drinks. The IV tube will come out after your child is drinking fluids well.

Pain management

Your child will feel pain after surgery. There are several ways to control pain. Your doctor and nurse will recommend the method they think will keep your child most pain free. Let your nurse know how well the pain is being managed. If you feel your child is in pain, tell the nurse.

Bladder spasms

After the surgery, your child may have bladder spasms. Bladder spasms happen because of irritation from the surgery and from the catheters in the bladder. When the bladder muscle spasms, your child may do the following things:

• suddenly get irritable
• draw his legs up
• complain of itchiness or pressure in his bottom

The nurse can give your child medicine that will help control the spasms. There are two types of medicine that can help reduce bladder spasms. One is orally taken by mouth. The other is a suppository, a pill that is put in your child's bottom.

Getting up and out of bed

Your child will be encouraged to get out of bed the day after surgery, with the help of pain medication. Getting up and moving around are an important part of getting better.

The nurse will also encourage your child to take big deep breaths and to cough. These actions will help your child get better faster.

Stitches on the incision

Your child will have a bandage covering the incision (cut). This will come off 4 to 5 days after the operation, or you will be asked to soak it off in the bath at home. The stitches underneath the bandage will dissolve on their own. This means that no stitches need to be removed after you take your child home.

Removing the catheter or catheters

Your child's doctor or nurse will discuss with you when the catheter(s) will be taken out and which tests need to be done before the child goes home. Your child may be discharged with a catheter in place. Your nurse will teach you how to care for the catheter at home and organize any home nursing or other supports you may need.

Key points
A ureteral reimplant is a surgical procedure to fix a ureter that is not connected to the bladder in the usual place. The surgery may take several hours. Your child will have one or more tubes after the surgery. These will need to stay in place for several days. Children can usually return to regular activities within about a week after the surgery.

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