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Ureteral Surgery

  • If your doctor has recommended ureteral surgery, you may be wondering what exactly this procedure entails and how the Department of Urology at Boston Children's Hospital can help you.

    We’ve put together information on the most common surgeries as well as a list of questions that are frequently asked of our doctors. We’ll give you some background on common conditions that require this kind of surgery, talk about your experience at the hospital when your child comes in for his procedure and discuss the long-term outlook for children who have ureteral surgical procedures.

    Here is some basic information about ureteral surgery:

    • Ureteral surgeries are procedures that fix problems with the flow of urine between the ureter (the tube that carries urine from the kidney to the bladder) and the kidney.
    • Your child may need ureteral surgery if she has a blockage in her ureter or has severe vesicoureteral reflux (VUR), in which your child's urine backs up the ureter into the kidney.
    • While ureteral surgery is not that common because many urinary tract problems go away on their own as your child grows or are not severe enough to damage the kidneys, the surgeons at Boston Children’s have a lot of experience performing these types of procedures.
    • Ureteral surgery – whether performed laparascopically (a minimally invasive procedure) or traditionally – is a fairly simple procedure with a high success rate.

    urinary tract

    How Boston Children's Hospital approaches ureteral surgery

    Children's is home to the largest pediatric urology department in the world, with physicians who are experts in a wide range of proven procedures. We perform more than 3,100 surgical procedures each year and care for almost 18,000 children from throughout the country and all over the world.

    The Robotic Surgery, Research and Training Program at Boston Children's Hospital provides unrivaled expertise in pediatric robotic surgery. Specially trained surgeons use a high-tech robot to perform complex and delicate operations through very small surgical openings. The results are less pain, faster recoveries, shorter hospital stays, smaller scars, and happier patients.

  • At Boston Children's Hospital, we understand that you may have questions about ureteral surgery, such as:

    • What is it?
    • What is the recovery process like?
    • How effective is the surgery?

    We’ve provided some answers to these questions below, and when you meet with our experts, we can talk with you more about your child’s specific situation.

    What is ureteral surgery?

    Ureteral surgery is performed to correct problems that cause urine to get backed up in the ureter and sometimes flow backward, which can permanently damage your child’s kidneys.

    Who needs ureteral surgery?

    Ureteral surgery is a treatment option for children who have abnormalities of their ureter and/or urinary tract, such as a blockage in the ureter or vesicoureteral reflux (VUR), a condition that causes urine to flow backward into the kidney.

    How common is this type of surgery?

    While VUR affects approximately 1 out of 100 babies and ureteral blockages occur in about 1 out of every 1,500 babies, not all of these children will need surgery. At Boston Children’s, we take a conservative approach, monitoring the function of your child’s urinary tract and kidney before deciding whether to perform surgery.

    At what age is ureteral surgery performed?

    It depends. If your baby has a large blockage in her ureter or severe VUR that affects her kidney function, your doctor may recommend surgery now. If his or her condition is less serious, your doctor will most likely choose to observe your child for a while before deciding whether to perform surgery.

    Are there different types of ureteral surgery?

    When surgery is required we can perform either a traditional open or a robotically assisted minimally invasive procedure. Your doctor will discuss with you which option is more suitable for your child’s unique situation.

    What is the long-term outlook for my child?

    Every child is unique, and your child’s long-term health depends upon her exact condition. But the bottom line is that with an accurate diagnosis, appropriate treatment and conscientious management, your child should go on to achieve normal urinary function.

    Questions to ask your doctor

    You and your family are key players in your medical care. It’s important that you share your observations and ideas with your treatment team and that you understand your provider’s recommendations.

    If you are scheduled for ureteral surgery and you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.

    Here are some questions you might want to ask:

    • How did you reach the decision that my child should have surgery at this time?
    • When should we have the surgery performed?
    • Is there anything we need to do to prepare for surgery?
    • Is it safe to use general anesthesia in children?
    • What will the recovery period be like?
  • At Boston Children's Hospital, we believe it is essential to undertake a thorough evaluation and diagnosis of your child’s condition before deciding whether to perform ureteral surgery. During the initial consultation, members of your child’s surgery team will perform a clinical evaluation. Your child's doctor may use one or more of the following tests to determine the severity of her obstruction in her ureter or vesicoureteral reflux (VUR) — and whether it will be necessary to undergo ureteral surgery:

    • ultrasound — This test gives us a good picture of your child’s urinary tract.
    • voiding cystourethrogram (VCUG): This special kind of x-ray is used to examine the anatomy of your child’s bladder and check for reflux.
    • computed tomography (CT) scan or MRI —These imaging tests can help your doctor get a more complete view of the condition that may require surgery.
    • other x-ray

    After these tests are completed, members of your child’s medical team will review the results to finalize the surgical plan.

    For more information about diagnosing reflux, see the page on vesicoureteral reflux (VUR). If you’d like more information about ureteropelvic obstructions, see the hydronephrosis page.

  • No one wants their child to have to undergo ureteral surgery, but it might help you to know that the caregivers in Boston Children’s Hospital's Department of Urology have a long and distinguished history of surgically repairing problems that affect the ureter and urinary system.Our expert team is committed to ensuring that your experience is as pleasant as possible.

    What is the goal of ureteral surgery?

    Ureteral surgery is performed to correct problems in your child’s ureter and allow urine to flow properly.

    Is there anything we need to do to prepare for the surgery?

    Your child’s doctor will give you a packet of information about what to do and not in the days leading up to your child’s surgery. These instructions include how long before the surgery your child should refrain from eating and drinking, when you should arrive at the pre-op clinic, what you should bring and how long you should expect to remain in the hospital.

    What happens during the surgery?

    It depends on your child’s condition. If your child has a blockage in her ureter, our surgeons disconnect your child’s ureter from his bladder, remove the blockage and then surgically re-position (reimplant) the ureter in the bladder wall.

    If your child has severe VUR, the surgeon will reconstruct the junction of the bladder and the ureter to prevent urine from flowing backward into the kidney.

    How does robotic-assisted laparascopic surgery work?

    Your child’s surgeon will insert instruments into his abdomen through small punctures, which are then used to perform the reconstructive procedures under the guidance of a small camera, also inserted through an incision.

    How does traditional open surgery work?

    In an open procedure, the surgeon makes an incision in the abdomen to expose your child’s bladder.

    Which method is better?

    Laparascopic surgery reduces the size of the incision, the amount of pain and the time your child will need to stay in the hospital, while traditional open surgery is a time-tested method of correcting these conditions with very few complications. Your doctor will discuss with you which option is better for your child.

    How long will recovery take?

    It depends upon which procedure your child has. Children who have robotic-assisted laparascopic surgery typically spend a day or two in the hospital, while children who have the traditional open procedure will spend three or four days in the hospital after surgery.

    What should we expect after surgery?

    Your child will most likely not feel very well when he is discharged from the hospital. This is entirely normal and full recovery from the surgery will take several days. Your nurse will give you a packet of information about how to care for your child in the days after the surgery.

    I’m worried about my child’s recovery. Should I call the surgeon?

    Absolutely. Call your child’s surgeon with any questions or if he experiences:

    • temperature over 101.0°F
    • excessive bleeding or rapid swelling
    • pain not relieved by prescribed pain medications

    What makes your approach unique?

    For most children, we take a conservative approach, which includes monitoring their condition through imaging as well as sometimes prescribing a course of antibiotics to prevent the urinary tract infections that can be caused by these ureteral problems.

    Should your child’s doctor deem that he need surgery, Boston Children’s surgeons have vast experience in both traditional open and minimally invasive robotic-assisted surgical procedures. You’ll meet with your child’s doctor and work together to design a customized plan of treatment that fits your child and his condition.

    Boston Children's pioneered the use of robotic surgery for complex procedures through small incisions, reducing pain, recovery time, and hospital stays. Today we perform more pediatric robotic surgeries than any other hospital in the world, and train physicians around the country to do them.

    Coping and support

    We understand that you may be worried about your child’s surgery. But there are lots of resources available for your whole family—within Boston Children’s, in the outside community and online.

    Our story: ureter reimplantation and megaureter repair

    My son, Luke Dangel, was admitted to Children’s Hospital Boston last September for ureter reimplantation and megaureter repair on his left side, which, while routine surgery at Children’s, was understandably scary and intimidating for us. Beyond the obvious skill and competence of everyone who interacted with Luke during his subsequent seven-day recovery, my husband and I were fully impressed and incredibly grateful for the compassion and care we received.

  • At Boston Children's Hospital, we’re continually learning from our experiences with patients, evaluating the most current data and studying the causes of diseases and new treatments with the aim of developing innovative methods for caring for kids.

    Boston Children's is the largest pediatric urology department in the world, with physicians who are experts in a wide range of proven procedures, from simple kidney stone removal to complete repair of bladder exstrophy (a rare birth defect in which the bladder is inside out and exposed outside the body).

    We perform more than 2,600 surgical procedures each year and care for almost 15,000 children from throughout the country and all over the world. Many urology "firsts" happened here. All of our expertise goes toward the same goal: treating and curing your child.

    Pain management after surgery

    Boston Children’s has been a pioneer in anesthesia for children, and our urologists and anesthesia doctors have worked together to develop highly effective pain-management techniques for children who have surgery for vesicoureteral reflux (VUR).

    Using these methods, most children recover quickly after surgery and their pain is kept to a minimum. Most children can go home within one or two days. In addition, we have been leaders in development of less invasive methods of correcting VUR. Our pioneering surgeons have used laparoscopic and robotic-assisted laparoscopic surgery to successfully correct VUR in many children. We also use endoscopic techniques (such as Deflux®) to perform injections to correct VUR in selected children.

    Less pain, smaller scars

    The Center for Robotic and Minimally Invasive Reconstructive Surgery at Boston Children's Hospital provides unrivaled expertise in pediatric robotic surgery. Specially trained surgeons use a high-tech robot to perform complex and delicate operations through very small surgical openings. The results are less pain, faster recoveries, shorter hospital stays, smaller scars, and happier patients.

    In 2001, Boston Children's was the first pediatric hospital to acquire a surgical robot. Today, surgeons use the technology for many procedures and perform more pediatric robotic surgeries than any other hospital in the world. Boston Children's physicians have developed a number of new applications for the robot, and train surgeons from around the world on its use.

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