Operative note 39 Advanced
Reimplantation in children
What it does: re-route a child's ureter into the bladder.
- Pfannenstiel. Open the bladder.
- Feeding tubes up both ureters.
- LOOK FOR DOUBLE SYSTEMS (2 orifices 1 side).
- Cut round the orifice.
- Free the ureter OUTSIDE the bladder wall first.
- Peel muscle off the ureter.
- Pull it in till it reaches skin level, no tension.
- New tunnel under the mucosa, 3-4x ureter width.
- 2 tunnels must not cross each other.
- Join mucosa to mucosa. First stitch deep, at the outer edge.
- 1-side job: small Y-V at the other ureter stops new reflux.
- Boys: supra catheter. Girls: urethral.
- Antibiotic cover 4 weeks. Scan at 6 weeks. Reflux study only if infection.
From the UroRef Operative Quick Guide.