✦ Posterior Urethral Valve Treatment

Ureterostomy / Upper Tract Diversion

Q: Why is upper tract diversion sometimes needed despite bladder decompression?

In massively dilated systems, the ureter loses peristalsis and the uretero-vesical junction malfunctions; direct ureteral diversion bypasses this problem.

Q: When is the ureterostomy closed?

Reconstruction is performed when the child is older, larger, and renal function has stabilised — typically at 12–24 months after initial diversion.

Q: Will both kidneys be diverted?

Diversion may be unilateral or bilateral depending on which upper tracts fail to decompress adequately with bladder drainage alone.

Upper Urinary Tract Diversion for PUV with Severe Hydronephrosis

60–90 min PROCEDURE

3–5 Days HOSPITAL STAY

>90% SUCCESS RATE

2–3 Weeks RECOVERY

What is Ureterostomy / Upper Tract Diversion?

Ureterostomy or upper tract diversion is performed for posterior urethral valve patients with massively dilated ureters and severe upper tract obstruction not adequately decompressed by bladder drainage alone. The dilated ureter is brought to the skin surface as a cutaneous ureterostomy, providing direct upper tract decompression and allowing maximum recovery of renal function before definitive reconstruction. This is a temporary measure — the ureterostomy is eventually closed and the urinary tract reconstructed. The procedure is performed under general or spinal anaesthesia with a hospital stay of 3–5 Days.

PUV patients with massively dilated ureters and severe hydronephrosis where bladder drainage alone fails to decompress the upper tracts adequately. Patients must be adequately fit for anaesthesia and free from active systemic infection before proceeding.

How the Procedure Works

Incision & Access

Flank or Gibson incision; dilated ureter identified and traced to the kidney.

Ureteric Delivery

Ureter brought to the skin surface through a separate stab incision.

Stoma Maturation

Ureterostomy matured by suturing ureteric edges to the skin.

Upper Tract Decompression

Upper tract decompresses; renal function monitored and expected to improve over weeks.

Reconstruction Planning

Reconstruction planned once renal function has stabilised and child is older.

Outcomes

60–90 minDURATION

3–5 DaysHOSPITAL STAY

>90%SUCCESS RATE

2–3 WeeksFULL RECOVERY

Who Needs This Treatment?

→Maximum upper tract decompression when bladder drainage is insufficient.
→Allows both kidneys to drain independently without bladder involvement.
→Protects and maximises recovery of renal function in severe cases.
→Avoids prolonged catheterisation in neonates with massively dilated systems.
→Temporary procedure with later reconstruction planned.
→Provides direct access to the upper tract for monitoring and intervention.

"Upper tract diversion in PUV is a demanding decision but sometimes the right one. When the ureter will not drain through the bladder, we take the direct route — and give the kidney the best chance of recovery."

— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon

Common Questions

Frequently Asked

Why is upper tract diversion sometimes needed despite bladder decompression?+

When is the ureterostomy closed?+

Will both kidneys be diverted?+

Not sure which treatment is right for you?

Book a consultation with Dr. Vipin Reddy and get a personalised treatment plan.

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