The ureters are long, thin tubes that carry urine from the kidneys to the bladder. Several different health problems can damage the ureters or impair their functioning, including large kidney stones, cancer, blood clots, or congenital defects. A ureter blockage can be very painful and lead to severe nausea, abdominal swelling, and blood pressure issues. Ureter surgery is necessary when medications and other non-invasive treatments fail to improve symptoms. There are several different variations of the surgery, and a team of specialists determines which type of procedure to perform on a patient-to-patient basis.
Most small stones, clots, and other types of blockages can be removed via a minimally-invasive ureter surgery. Operations can usually be performed laparoscopically, which involves making one or more small incisions and manipulating tools to clear the blockage. A thin fiber optic tube called an endoscope is inserted through the urethra or a small cut in the abdomen. A surgeon guides the endoscope to the damaged ureter to inspect it and locate the blockage. A precision scalpel, ultrasonic device, or electric probe can then be used to break up the obstruction.
Once a blockage is cleared, the surgeon can insert a temporary catheter in the ureter or bladder, remove the endoscope, and suture the skin incision. Catheters allow urine to bypass the surgical site so the ureter has time to heal. Most laparoscopic surgeries can be performed in less than two hours, and patients generally need to stay in the hospital for two to four days following surgery so doctors can monitor their recovery. If a patient is healing well after a few days, the catheter is removed and he or she is allowed to go home. Follow-up visits in the first few weeks after surgery are important to make sure the condition has been entirely resolved.
If a ureter is badly damaged, ruptured, or deformed, open ureter surgery may be necessary. A long incision is made in the side or lower back to give the surgeon direct access to the ureter. The surgeon can choose to reposition the tube, cut away damaged sections, or remove the entire ureter if it is beyond repair. If the ureter is removed, the kidney and bladder are usually stretched closer together and grafted tissue is used to fashion a new connecting tube.
Recovery time following open ureter surgery can vary, but many patients need to stay in the hospital for at least two weeks. Catheters are inserted and intravenous antibiotics, fluids, and pain relievers are given. People may need to limit their physical activity and dietary intake for several months to promote full recoveries.