ureteroneocystostomy

Ureteroneocystostomy, also called uretero-vesical reimplantation, is a surgical procedure that reattaches a damaged or obstructed ureter to the urinary bladder. The goal is to restore reliable drainage from the kidney into the bladder and, when possible, to establish a submucosal tunnel that reduces vesicoureteral reflux.

Indications include injury or obstruction of the distal ureter due to pelvic or abdominal surgery, ureteral stricture, or certain congenital ureteral anomalies. It is also used to treat vesicoureteral reflux in adults or select pediatric cases when conservative management is not appropriate.

Open, laparoscopic, and robotic approaches are used. The procedure may be performed intravesically or extravesically. Extravesical techniques (for example, Lich-Gregoire) create a bladder wall tunnel to provide a valve-like anti-reflux mechanism, while intravesical approaches involve attaching the ureter within the bladder mucosa and creating a low-pressure channel.

Typical steps include mobilizing the distal ureter, preparing a spatulated ureteral end, creating the bladder incision or tunnel, and performing a watertight ureteroneocystostomy. A ureteral stent and sometimes a drain are placed, and the bladder is closed. Stent removal occurs days to weeks after surgery, depending on the method.

Outcomes are generally favorable with relief of obstruction and reflux in many patients. Complications can include anastomotic leak, ureteral stricture, persistent reflux, infection, or bladder dysfunction, though rates are relatively low with experienced surgeons.