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.

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.

While VUR affects approximately one out of 100 babies and ureteral blockages occur in about one 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.

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.

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.

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.

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?

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

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.

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 reposition (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.

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.

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

Laparoscopic 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.

It depends upon which procedure your child has. Children who have robotic-assisted laparoscopic 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.

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.

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

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.