Ureteric Reimplantation
Surgical correction of ureteric anatomy to create an effective anti-reflux valve — eliminates the structural cause of recurrent pyelonephritis and protects kidneys from ongoing scarring.
What is Ureteric Reimplantation?
Ureteric Reimplantation is a reconstructive procedure in which the ureter is detached from its original bladder insertion and reattached at a new site through a submucosal tunnel that creates an anti-reflux valve mechanism. It corrects vesicoureteral reflux, obstructive megaureter, stricture at the vesicoureteric junction, or post-traumatic ureteric injury. By restoring normal anatomy, it eliminates the structural cause of recurrent complicated urinary tract infections and protects kidneys from ongoing scarring. Success rates exceed 95% for grades III–V VUR using established Cohen's or Politano-Leadbetter techniques.
How the Procedure Works
Incision & Exposure
Lower midline or Pfannenstiel incision; bladder opened through cystotomy for intravesical approach or detrusor dissected for extravesical approach.
Ureteric Mobilisation
Relevant ureter identified, carefully mobilised with blood supply preserved, and divided from original insertion with adequate length retained.
Tunnel Creation
Submucosal tunnel of 3–4 cm created in bladder mucosa at new implantation site — minimum 5:1 tunnel-to-ureteric diameter ratio required.
Ureteric Anastomosis
Spatulated ureter drawn through tunnel and anastomosed to bladder mucosa with 4-0 absorbable sutures; DJ stent placed through anastomosis.
Closure & Drainage
Cystotomy closed in two layers; urethral catheter and pelvic drain placed; DJ stent removed at 4–6 weeks after post-operative imaging confirmation.
Outcomes
Who Needs This Treatment?
- →Children and adults with grades III–V vesicoureteral reflux causing recurrent pyelonephritis and renal scarring.
- →Patients with obstructive megaureter causing hydronephrosis and repeated complicated urinary tract infections.
- →Those with ureteric stricture at the vesicoureteric junction from prior surgery, radiation, or endoscopic injury.
- →Patients with ureteric injury from gynaecological surgery requiring urgent reconstruction to preserve kidney function.
- →Children with breakthrough infections on prophylactic antibiotics where medical management of VUR has failed.
- →Those with reflux nephropathy at risk of progressive hypertension and renal failure if anatomy left uncorrected.
"Ureteric reimplantation corrects the root cause of reflux-related infections. By restoring normal anatomy with a proper anti-reflux mechanism, we protect kidneys from the ongoing scarring that eventually leads to hypertension and renal failure."
— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon
Common Questions
Frequently Asked
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