Ureteroneocystostomy is a reconstructive surgical procedure designed to repair or create a proper connection between the ureter and the bladder. The ureters are the tubes that carry urine from the kidneys to the bladder, and this surgery focuses on the lower segment near its entry point. The primary goal is to ensure urine flows forward into the bladder while preventing it from flowing backward, or refluxing, toward the kidneys. This repair protects the upper urinary tract from damage caused by pressure or infection.
Conditions Treated by the Procedure
The most frequent reason for performing a ureteroneocystostomy, particularly in children, is to correct Vesicoureteral Reflux (VUR). VUR occurs when the valve mechanism at the junction of the ureter and bladder is defective, allowing urine to flow backward up the ureter and toward the kidney. This reverse flow can carry bacteria, leading to recurrent kidney infections.
Ureteroneocystostomy creates a new, properly functioning one-way valve to stop the backward flow of urine. In adults, the procedure is more often used to address damage or blockage in the lower third of the ureter, known as ureteral strictures. These strictures can be caused by scar tissue from previous surgeries, trauma, or conditions like pelvic malignancy. The surgery is also a standard part of a kidney transplant, where the donor ureter must be connected to the recipient’s bladder.
The Surgical Process
The surgeon carefully detaches the ureter from its original entry point in the bladder. The ureter is then repositioned and tunneled obliquely through the wall of the bladder muscle before its open end is sutured to the bladder lining. This submucosal tunnel provides a mechanism of compression. When the bladder fills with urine, the pressure inside compresses the ureter within the tunnel, effectively closing the connection and preventing reflux.
The procedure can be performed using several approaches, which influence the size of the incision and the patient’s recovery time. The traditional open approach requires an incision, often in the lower abdomen, to access the bladder and ureters directly. Minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, use several small incisions through which specialized instruments and a camera are inserted. These methods often lead to a shorter hospital stay.
In cases where a significant length of the ureter must be removed, the surgeon may employ specialized modifications to ensure a tension-free connection. Techniques include the psoas hitch, which involves mobilizing and anchoring the bladder to a muscle in the pelvic sidewall to bridge a gap. Another modification, the Boari flap, uses a section of the bladder wall to create a tube that extends the connection to the ureter.
Immediate Recovery and Hospital Stay
The duration of the hospital stay typically ranges from one to three days, with minimally invasive approaches often allowing for a shorter stay than traditional open surgery. Pain management is a priority, and medication is provided to control discomfort related to the incision and internal repair.
Temporary tubes are placed to assist with drainage and healing. A Foley catheter is placed in the bladder during surgery to drain urine and keep the bladder empty, allowing the newly repaired connection to rest and heal. This catheter is usually removed within a few days.
Some patients may also have a small drain placed near the surgical site to remove fluid accumulation. A ureteral stent may be temporarily placed inside the ureter to ensure urine flows from the kidney to the bladder without obstruction. Temporary side effects include hematuria (blood in the urine) and bladder spasms, which are often managed with specific medication.
Long-Term Outlook and Follow-Up Care
The long-term outlook following a ureteroneocystostomy shows high rates of success in permanently resolving reflux or ureteral obstruction. For Vesicoureteral Reflux, the procedure successfully eliminates reflux in the vast majority of cases. Full recovery, including a complete return to normal activities, typically occurs within four to six weeks.
Follow-up care confirms the success of the repair and monitors the long-term health of the upper urinary tract. Post-operative imaging is routine, including a renal ultrasound to check the size and structure of the kidneys. For VUR, a Voiding Cystourethrogram (VCUG) may be performed several months after surgery to definitively confirm that the backward flow of urine has been eliminated.
Potential long-term complications, although uncommon, include the development of a ureteral stricture (a narrowing of the new connection) or the persistence of reflux. These issues are typically detected during follow-up imaging and may require further intervention. Continued monitoring of kidney and bladder health is advised for several years after the procedure.