Ureteral Reimplantation (Robotic, Laparoscopic and Open)

Ureteral reimplantation detaches the lower end of a ureter, the tube that carries urine from a kidney, and joins it to the bladder in a new position. In children it is done mainly for vesicoureteral reflux, where urine flows backwards to the kidney. In adults it is done for a narrowing or injury of the lower ureter, often following pelvic surgery, radiotherapy, stones or endometriosis.

It restores free, one-way drainage and protects the kidney, with success above 90 to 95 percent. It cannot recover kidney function already lost to scarring, and many children with low-grade reflux outgrow it and never need surgery.

What Ureteral Reimplantation (Robotic, Laparoscopic and Open) involves

In the robotic approach, four or five small ports are placed in the abdomen. The ureter is traced down to the bladder, freed while preserving its delicate blood supply, and divided above the diseased segment. For reflux, a trough about 3 to 5 centimetres long is cut in the bladder muscle, the ureter is laid in it and the muscle is closed over it to create a flap-valve tunnel (Lich-Gregoir technique). For stricture, the healthy ureter is stitched to a new opening in the bladder dome; if it will not reach without tension, the bladder is hitched up to the psoas muscle or a Boari flap of bladder wall is fashioned into a tube. A JJ stent and bladder catheter are left in place. In small children the classic open operation is performed from inside the bladder through a short bikini-line incision.

Who is a good candidate for Ureteral Reimplantation (Robotic, Laparoscopic and Open)?

The decision rests on imaging such as a voiding cystourethrogram, DMSA or MAG3 scan and CT urogram, together with infection history.

• Children with high-grade reflux (grades IV to V), breakthrough kidney infections despite preventive antibiotics, or new kidney scarring
• Reflux that persists as the child grows, or failed endoscopic injection treatment
• Adults with a benign stricture or surgical injury of the lower third of the ureter
• Obstructed megaureter or ureterocele with loss of function
• Distal ureteral endometriosis or a localised tumour requiring segment removal

It is usually not the right choice if:

• Low-grade reflux without infections, which commonly resolves with growth
• Untreated bladder and bowel dysfunction in children, which should be managed first because it makes surgery fail
• Strictures in the upper or middle ureter, which need different reconstructions
• A kidney with negligible function, where removal may be more appropriate
• Active urinary infection at the time of surgery

Technique options

• Open intravesical reimplantation (Cohen): The reference technique in young children, with success of 95 to 98 percent.
• Robotic or laparoscopic extravesical reimplantation (Lich-Gregoir): Small wounds and short stay; suited to older children and adults.
• Psoas hitch and Boari flap: Bridge gaps of roughly 5 to 15 centimetres when a segment of lower ureter has been lost.
• Endoscopic bulking injection: A day-case alternative for reflux with lower success of around 70 to 85 percent and possible recurrence.

What happens during your treatment

Surgery takes 2 to 4 hours under general anaesthesia. You wake with a bladder catheter, kept for 2 to 10 days depending on how much bladder reconstruction was needed, and sometimes a drain. Bladder spasms and blood-tinged urine are common for a few days and eased with medication.

Preparing for your trip

Plan for 10 to 14 days in Istanbul. Your surgeon reviews photographs and your medical history before you book, and you meet in person the day before surgery for examination, marking and consent with a professional interpreter.

• Stop smoking and nicotine at least four weeks before and after surgery; it is the single biggest avoidable cause of wound problems
• Tell the team about every medicine and supplement you take; blood thinners, some herbal products and hormone treatment may need to be paused on your doctor's advice
• Arrange for someone to travel with you or to be reachable, and keep the first days at home free of work and lifting
• Book a changeable return flight; your surgeon confirms when you are fit to fly

Recovery and results

Hospital stay is 1 to 3 nights after robotic surgery and 2 to 5 after open surgery. The stent is removed after 2 to 6 weeks; in children this requires a brief general anaesthetic unless a stent on a string is used. Avoid heavy lifting and sport for 4 weeks. An ultrasound at 4 to 6 weeks and 3 months checks that the kidney is draining, and a renogram is added if swelling persists.

• Back to everyday activity: 2 to 4 weeks
• When results show: Drainage confirmed on scans at 6 to 12 weeks
• How long they last: Permanent in more than 90 to 95 percent

Safety, risks and revision policy

The procedure is dependable, but the ureter has a fragile blood supply and problems occasionally follow.

• Narrowing at the new join causing kidney swelling, in about 2 to 5 percent, sometimes needing dilation or re-operation
• Persistent or new reflux, occasionally on the opposite side
• Urine leak from the bladder or the join
• Urinary infection and stent discomfort
• Temporary difficulty emptying the bladder, mainly after both sides are done outside the bladder
• Bleeding or injury to bowel or pelvic vessels, which is rare
• Reduced bladder capacity for some months after a Boari flap

Every written proposal arranged through Clinic-Y states what the clinic covers if a correction is needed. Ask for it before you book, not after.

Cost of Ureteral Reimplantation (Robotic, Laparoscopic and Open) in Türkiye

Clinic-Y does not publish a single price for Ureteral Reimplantation (Robotic, Laparoscopic and Open), because the honest figure depends on your case. What moves it:

• Robotic, laparoscopic or open approach
• One or both ureters
• Need for a psoas hitch or Boari flap
• Hospital nights and paediatric anaesthesia
• Imaging before and after, and stent removal

Send your photographs or reports and you receive written, all-inclusive proposals from suitable teams, side by side. Reviewing your case is free.

Frequently Asked Questions