What Is an Ureteroureterostomy?
An ureteroureterostomy is a surgery done to help the kidney drain urine (pee) down to the bladder. This operation is sometimes done in children who have what is called a “duplex kidney.” Instead of the usual single tube (ureter) that drains pee from the kidney down to the bladder, one or both of the kidneys has two tubes. Ureteroureterostomy connects the two tubes to make a Y-shaped drain.
An ureteroureterostomy leaves only one entrance to the bladder, through the healthy tube. For blocked tubes, the surgeon snips the tube above the blockage and connects it to the other healthy tube. For tubes that drain outside the bladder, the surgeon separates the tube from wherever it is draining and brings it over to attach to the healthy tube.
There are three possible ways the surgery may be done:
- Open surgery – A small opening or cut (a couple of centimeters wide) is made in the lower belly. The skin is pulled aside so the surgeon can see and work directly inside the child. This is usually done in small babies.
- Laparoscopic surgery – Three tiny cuts (a few millimeters wide) are made in the lower belly. The surgeon holds long, thin instruments and a camera inside the tiny holes and operates using these long instruments, from the outside of the belly.
- Robotic surgery – Three tiny cuts (several millimeters wide) are made in the lower belly. The surgeon uses a computer to control the robotic arms, which move small tools underneath the skin in the belly to do the operation.
Over time, a kidney that doesn’t drain properly can be damaged. Children may get a lot of urinary tract infections (UTIs) or have pain, kidney swelling, or other problems. An ureteroureterostomy can help fix and prevent such problems.
If the kidneys and tubes work well and there is no swelling or infection, surgery may not be needed for duplex kidneys. However, an ureteroureterostomy may be needed if:
- There is a blocked tube (obstruction). This means urine has trouble getting down to the bladder through the tube. Over time, this causes damage to the kidney.
- Urine flows back into the urine tube and kidney after draining into the bladder. This is called vesicoureteral reflux. It can cause infection, scarring, or swelling in the kidney (hydronephrosis).
- The urine drains somewhere other than the bladder (ectopically). For example, in some girls the extra tube may drain into the vagina. This causes steady leakage of urine that can only be fixed with surgery.
Once a problem is diagnosed and the doctor says surgery is needed, your child will be scheduled for the operation. If your child is younger than 6 months, the doctor may recommend that the procedure be delayed until 6 months of age unless they have already lost some kidney function. An ureteroureterostomy is not an emergency surgery.
A nurse from Nationwide Children’s will call 1-3 days before the operation to give instructions and the exact time of the surgery. The nurse will let you know when to arrive, when your child needs to stop eating or drinking, and any other information you need to know for the operation. No matter what technique the surgeon uses, ureteroureterostomy requires an overnight stay at the hospital.
- Your child will need general anesthesia (medicine to make him or her fall asleep). After being put to sleep with anesthesia, the whole process takes about 3 hours. Some very young children may not need to be completely asleep and may have the surgery done under a spinal anesthetic.
- He or she will be given at least one dose of antibiotics to help lower the chance of an infection at the site of the incisions.
- Your child may have drainage tubes as a result of surgery. This could include an urethral catheter and a stent (a small tube made out of plastic) that is left internally in the good tube to help enable proper healing.If a stent is left, it often has to be removed through a separate, short outpatient surgery.
- In the recovery room, your child will be checked for complications. After about an hour, your child will be sent to a room for observation overnight. If there are no signs of a problem, he or she will be given pain medicine and sent home the following day. The urethral catheter will be removed either the day of discharge or a few days after discharge, in young babies.The stent may be removed several weeks later as a separate procedure that does not require any cuts – but does require going through the normal anatomy to remove.As a result, this is done in the operating room under a brief anesthetic.
Your child will have to return to the hospital in 4-6 weeks for removal of the stent. For removal, your child will be put to sleep again with anesthesia, but should be able to go home the same day. No cuts will be needed to remove the stent. The doctor will also order an ultrasound about 2 months after the stent is removed to check the kidney and urine tubes. There is often some swelling of the kidney and tubes on this ultrasound, but that does not mean surgery failed.
You should also expect the following after an ureteroureterostomy:
- The incisions are usually closed with skin glue and absorbable stitches. These do not need to be removed; they disappear on their own.
- Your child can return to regular bathing (for babies) or showering about 48 hours after the operation.
- Blood may appear in the urine until the stent is removed. This is normal.
- The site of the cut may be sore for a few days or weeks. Some children have discomfort or a little pain from the stent the entire time it is in place.
- Older children should avoid contact sports until the stent is removed.
You should call the doctor or seek medical attention for your child after an ureteroureterostomy if your child:
- Has a fever of 101° F or higher before the follow-up appointment to review the ultrasound
- Passes blood clots in the urine
- Complains of severe pain in the belly, side or back that isn’t helped by the pain medicine they are given at discharge
- If vomiting and cannot stay hydrated
When ureteroureterostomy is needed, it can help with constant urine accidents or protect kidney function and prevent urinary tract infections. When the kidney and its drainage tubes work as they should, your child will be less likely to have pain, infections and other problems.
An ureteroureterostomy can protect the function of the affected kidney (or affected part of the kidney if your child has duplex kidneys). Having two healthy kidneys gives your child the chance for better health down the road in case another health problem injures or affects the kidneys.
During surgery on the kidney, urine can leak into other areas and cause some irritation. Other risks of ureteroureterostomy include those of any surgery, such as infection, redness, swelling, bleeding, or failure of the operation to fix the problem.
Rarely, the place where the tubes are joined together forms a scar that blocks urine from getting to the bladder. It may require another operation to cut open the scar tissue or make a new attachment so that urine flows through the Y-shaped tube correctly. Sometimes this can be fixed by dilating the connection in radiology without another surgery.
Consider asking the doctor the following questions before your child undergoes surgery:
- Why is an ureteroureterostomy needed?
- How soon is it needed?
- Could the condition resolve on its own if surgery is delayed?
- What would happen without surgery?
- Are there other treatment options available?
- What should we know about the hospital stay?
- How long should recovery take?
- What surgical techniques are available?
- What technique does the doctor recommend, and why?
- What are the potential risks and benefits for your child?
All urologists at Nationwide Children’s can perform an ureteroureterostomy. Depending on your child’s age and activity level, the urologist will recommend either open surgery or minimally invasive surgery (robotic or laparoscopic). The benefits of minimally invasive surgery for patients who are good candidates include faster healing time, less pain, smaller scars and — under certain circumstances — higher success rates.
Regardless of the technique, physicians at our hospital take a conservative approach to operating so that your child does not undergo the operation unnecessarily. When possible — for example, for very young babies with minor reflux or only minor swelling in the kidney — surgeons at Nationwide Children’s may recommend a “watch and wait” approach. This means they may prefer to wait a few months and then do another assessment of your child’s kidneys.
If the problem goes away or shows improvement by the follow-up imaging, your child may not need an ureteroureterostomy after all. In fact, most children with duplex kidneys do not require surgery (unless they have an ectopic tube).
If your child needs surgery, you can rest easy knowing that our skilled surgeons routinely perform this operation. From diagnosis and scheduling to surgery and follow-up, your family will have the opportunity to speak in-depth with our expert physicians and nursing staff at each point of their care journey.
