Reconstruction of the ureter (re-fashioning of drainage of urine to the bladder after scarring or damage to the ureter)

What is this?

This describes a number of procedures to re-establish drainage of urine into the bladder when it has been interrupted because of scarring or damage to one of the ureters (the tubes which drain urine from the kidney to the bladder)

What alternatives are there?

Long-term drainage with a ureteric stent, nephrostomy tube (external drain), conservative management (leaving the kidney to lose its function spontaneously).

What to expect before procedure

If you are taking Aspirin or Clopidogrel on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. You will usually be admitted on the day before your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will also be given an injection under the skin of a drug (Clexane(®) which, along with elasticated stockings provided on the ward, will help prevent thrombosis (clots) in your veins.

What happens during the procedure?

A full general anaesthetic (where you are asleep throughout the procedure) will normally be used. A bladder flap and hitch Drainage may be re-established by a variety of means; by directly re-joining the ends of the ureter above and below the area of blockage, by re-implanting the ureter into the bladder, by fashioning a tube of bladder to reach up to the ureter above the blockage (a bladder flap), by transferring the end of the blocked ureter over to the ureter on the other side or by replacing the ureter along its whole length with a segment of intestine (bowel). The choice of procedure will be discussed with you in detail by your Consultant. However, it is often not clear before the operation which procedure will be most appropriate for your particular problem, so a range of options are usually discussed.

After the procedure

An internal drain (ureteric stent) is usually placed across the join where the blockage has been in order to allow free drainage of urine into the bladder and to avoid leakage outside the ureter. There will be a drainage tube close to the wound to drain fluid away from the internal area where the operation has been done. There is usually a catheter in the urethra (water pipe) and, possibly, an additional catheter directly into the bladder through the skin of the lower abdomen (a suprapubic catheter). After the operation, you may spend some time in the Intensive Care Unit or in the Special Recovery area of the operating theatre before returning to the ward. You will normally have a drip in your arm and, occasionally, a further drip into a vein in your neck. You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid and food as soon as possible. We normally use elastic stockings to minimise the risk of blood clot (deep vein thrombosis) in your legs. A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time after your operation. If you have a drain or a tube in your blocked kidney (a nephrostomy tube), this may be removed on the ward or at a later stage after your discharge. The average stay in hospital will last approximately 10-14 days.

Potential side effects