The ureter is a muscular tube responsible for transporting urine from the kidney, where it is produced, down to the bladder for storage. A ureterectomy is a surgical procedure involving the removal of this tube, either in its entirety or just a segment of it. This operation is performed when a localized disease or injury compromises the function or health of the ureter. The procedure requires careful surgical planning to address the underlying condition while preserving as much of the remaining healthy urinary tract as possible.
Conditions Requiring Ureterectomy
Urothelial carcinoma, also known as transitional cell cancer, arises from the lining of the urinary tract. When this cancer affects the ureter or the renal pelvis (the funnel-like area in the kidney), a complete removal of the kidney, the entire ureter, and a cuff of the bladder (nephroureterectomy) is often necessary. This extensive removal ensures all cancerous tissue is removed due to the high risk that cancer cells may have spread along the lining of the upper urinary tract.
Ureterectomy may also treat severe, non-cancerous conditions like extensive ureteral strictures. A stricture is a narrowing of the ureter that obstructs the flow of urine, often caused by scar tissue, kidney stones, or prolonged irritation. If the narrowed segment is long or fails to respond to less invasive treatments, removing that specific segment (segmental ureterectomy) can re-establish proper urine drainage.
Irreparable traumatic injury to the ureter, such as severe crushing or damage from external trauma or complex pelvic surgery, is another reason for removal. If the injured section cannot be repaired by reconnecting the ends (ureteroureterostomy), the segment must be excised. The goal is to remove the affected tissue and reconstruct the urinary tract to prevent urine backup, which can lead to infection and progressive loss of kidney function.
Surgical Methods and Approach
Ureterectomy procedures are classified based on the extent of tissue removed. A total ureterectomy involves removing the entire length of the ureter, often with a nephrectomy for upper tract urothelial carcinoma. A partial or segmental ureterectomy removes only a diseased portion, allowing the surgeon to re-connect the remaining healthy ends or re-implant the ureter into the bladder, sparing the kidney.
The surgical approach can be open or minimally invasive, depending on the condition and surgeon’s expertise. Open surgery involves a single, larger incision in the flank or abdomen, providing direct access to the ureter. This approach is often used for very large tumors or complex reconstructions due to the unrestricted ability to excise the tissue en bloc.
Minimally invasive techniques include laparoscopic and robotic-assisted surgery, utilizing several small “keyhole” incisions for specialized instruments and a camera. The robotic approach offers a three-dimensional, magnified view and instruments with a greater range of motion, advantageous for complex dissection and fine suturing. Minimally invasive procedures generally result in less blood loss, reduced post-operative pain, and a shorter hospital stay compared to open surgery. These methods have become increasingly common, offering patients a faster return to normal activity.
Hospital Stay and Recovery Timeline
The immediate post-operative period focuses on pain management, often using intravenous medication or patient-controlled analgesia (PCA) pumps. Patients typically have a temporary urinary catheter draining the bladder, which remains in place for several days to allow the bladder to rest and heal. A surgical drain may also be placed near the incision site to collect fluid or minor leakage, and this is removed before discharge.
The length of the hospital stay depends on the surgical approach. Patients undergoing a minimally invasive procedure often stay for one to three nights. Those who have open surgery, especially a radical nephroureterectomy, may require four to six nights due to the larger incision and greater physiological stress. Early mobilization, such as walking soon after surgery, is encouraged to prevent complications like pneumonia and blood clots.
After discharge, recovery typically requires four to eight weeks. Light activities and a return to desk work are often possible within two to three weeks following a minimally invasive procedure, or four weeks after open surgery. Patients must strictly avoid heavy lifting for a full six weeks to prevent a hernia at the incision site.
Some patients receive a temporary ureteral stent, a small tube placed inside the ureter to ensure urine flows from the kidney to the bladder while the surgical site heals. The stent is usually removed a few weeks after the operation. Patients are monitored for signs of infection, significant bleeding, or a urine leak, which presents as persistent drainage from the wound or drain. Full return of the body’s energy level and stamina may take several weeks to months.