Gynecologic surgery that may include a hysterectomy is one of the leading causes of ureteral injuries that may affect women. The tubes that connect the kidneys and bladder (ureters) may also become injured or misaligned during other types of pelvic surgery. Misaligned ureters can result in problems with urine control and increase the risk of experiencing recurring urinary tract infections and kidney-related issues.
Some women also develop a backup of urine into the kidneys (vesicoureteral reflux) because of issues with one or both ureters. One way this problem may be resolved is with a ureteral re-implant procedure.
Girls are sometimes born with ureters that are positioned incorrectly. If this turns out to be the case, ureteral re-implant surgery may be performed at an appropriate age. Adult women may develop urine flow problems if their bladder muscle falls out of alignment with attached ureters. This may happen if a woman sustains a serious abdominal or pelvic injury or has surgery involving the bladder or similar structures. Signs suggesting that there may be a bladder-ureter misalignment include:
Before a ureteral re-implant is performed, women typically have a kidney and bladder scan to confirm that symptoms experienced are related to misaligned ureters. This process may include tests to rule out other possible reasons for urine management problems. A voiding cystourethrogram (VCUG) might be done as the bladder is emptying to determine how much urine is being expelled and how much is remaining in place after voiding (urinating).
If it’s decided that surgery is the most appropriate option, a ureteral re-implant is performed under general anesthesia. While surgery of this nature is sometimes performed as a traditional open procedure, meaning a large incision is made in the lower abdominal area, it’s becoming increasingly common to use minimally invasive surgical techniques to perform a ureteral re-implant. For women having this procedure done in a minimally invasive way, smaller incisions are made to access the affected area. Additionally, patients may enjoy benefits that include a faster healing and recovery period, less post-op discomfort, and fewer surgical risks.
During the procedure, one or both ureters are moved and re-positioned in a way that restores normal alignment with the bladder. A catheter is also used during the procedure to ensure that the bladder remains empty. If a woman experienced injuries from a crushing clamp, sealing device, or some other type of surgical instrument used during a previous pelvic procedure, there may be a need to make additional surgical corrections to restore the bladder’s ability to transport and store urine properly.
After a ureteral re-implant procedure is completed, a cystoscopy may be performed to assess the lower urinary tract and make sure that the bladder is emptying correctly. Antibiotics are sometimes prescribed post-procedure as well to reduce the risk of urinary tract infections. Another post-op evaluation that may take place is an ultrasound scan to determine if urine if flowing correctly from the ureters to the bladder and not back up to the kidneys.