Reimplantation

Ureteric implantation is a surgical procedure mostly done in children and patients who have been diagnosed with vesico-ureteric reflux. Here the urine flows back up or reflux the ureter to the kidney with increase in bladder pressure. Recurrence of reflux over time and normal growth of kidneys is inhibited in children surgical treatment is necessary. Patients with reflux are susceptible to develop urine infections, causing kidney scarring and damage .As the severity increases, the ureter and kidney becomes inefficient and cause distortion in their structures.

A ureteric reimplantation may be done on one (unilateral) or both (bilateral) ureters that need repairing. The valve where the ureter enters the bladder is repaired during the operation and prevents the reflux from occurring again. The patient is anaesthetized before the surgery. A small incision is made in the bikini line through which the bladder can be approached and opened. A small circular incision is made around the opening of the ureter. The ureter is dissected and made free from the bladder muscle. Once the movement of the ureter is made smooth through this opening or when the urethra can slide in and out of the bladder wall freely, then a small tunnel of about 2 cm long is created for each ureter, with the end opening into the bladder. Through this tunnel the ureter is then passed through to the bladder and stitched into place. So when the bladder muscle contracts to pass urine, the urine flow backwards to the kidneys is stopped by pressing the sides of the ureter together. The site of the original opening of the ureter is then closed and the bladder is also closed.

A catheter is placed in the bladder to drain urine out of the bladder until the wounds are totally healed. All the stitches except one holding the catheter in place are dissolving ones the wounds are then dressed up to prevent infection and bleeding. The operation takes 2-3 hours and requires a hospital stay of two days. After 6 months ultra sound scan of the kidneys is performed to make sure the ureters are not blocked again. Reimplantation operation is a very effective for treating reflux and eliminates possibilities of long-term complications such as severe kidney damage.