Academic Medical Center
Comprehensive Nephrology & Transplant
Joint CommissionMagnet RecognitionUNOS Transplant Center
✓ 24/7 ER✓ ICU✓ Insurance
Ureteral reimplantation
Ureteral reimplantation is a surgery that reattaches a ureter to a new spot on the bladder wall, so urine drains properly and can't flow back toward the kidney. It is used to correct reflux or blockage and to protect kidney health.
Content verification
Briefly about this treatment
Indications
Vesicoureteral reflux with repeated kidney infections or kidney scarring, an obstructed or widened ureter (megaureter), or a ureter injured or narrowed by surgery, stones or radiation — when monitoring, antibiotics or less invasive options are not enough.
Risks
Bleeding, urinary infection, urine leakage and bladder spasms; rarely, narrowing or return of reflux at the new connection. Risks are minimized by careful patient selection and experienced surgical teams.
Pre-procedure
Urine and blood tests, kidney and bladder ultrasound, a voiding cystourethrogram (VCUG) or CT/MR urogram where needed, anesthesia consultation, fasting per protocol.
Follow-up
Catheter or stent removal within days to weeks, then an ultrasound (sometimes a repeat VCUG or renal scan) at roughly 1–3 months, with scheduled clinic visits to monitor kidney growth, infections and kidney function over the following years.
What is Ureteral reimplantation? An expert explains
Normally, the last stretch of the ureter runs through the bladder wall at an angle, inside a short tunnel of muscle. When the bladder fills and contracts, that muscle presses the tunnel shut — a one-way valve that lets urine in but not back out. If the tunnel is too short, misaligned, or damaged, the valve doesn’t close properly, and urine can reflux toward the kidney or drainage can become blocked.
During surgery, the surgeon detaches the ureter from its original opening, creates a new, correctly angled tunnel through the bladder wall and muscle, and reattaches the ureter inside it so the valve works as intended. It can be done as open surgery (a small lower-abdominal incision), laparoscopically, or with robotic assistance, and either outside the bladder (extravesical, e.g. the Lich–Gregoir technique) or through the inside of the bladder (intravesical, e.g. Cohen or Politano–Leadbetter). In adults who have lost part of the ureter to injury, a stricture, or a tumor, surgeons often add a psoas hitch (anchoring the bladder to a nearby muscle) or a Boari flap (a tube fashioned from bladder tissue) to bridge a longer gap without tension.
Signs it may be time for Ureteral reimplantation
Many people with a ureter problem feel nothing at all — children with reflux are often found after a urinary infection or an antenatal scan. When symptoms do appear, they usually point to infection or to urine not draining well. Having one of them does not mean you need surgery; it means the urinary tract is worth checking.
Symptoms you may notice
- Fever with a urinary infection, again and again. In children this is often the first sign. Babies may only seem irritable, feed poorly or vomit, so a fever with no clear cause deserves a urine test.
- Burning or pain when passing urine. It may come with a frequent or urgent need to go, and urine that looks cloudy or smells strong.
- Pain in the side or lower back (flank). This can be a sign that urine is backing up toward the kidney, and it sometimes gets worse while passing urine.
- Blood in the urine. It may look pink, red or tea-colored, and is worth mentioning to a doctor even if it settles.
- Leaking urine or persistent flank pain after pelvic surgery. In adults, these can signal that a ureter was injured or narrowed during an earlier operation.
- New daytime or night-time wetting in a child who was dry. This is not specific, but it can be linked to urinary tract problems and is worth raising.
Conditions linked to ureteral reimplantation
These are the conditions most often treated with ureteral reimplantation, or where it is considered when other options have not worked:
- Vesicoureteral Reflux (VUR) — urine flows backward from the bladder toward the kidney; the most common reason for this surgery, mainly in children.
- Hydronephrosis — swelling of the kidney from urine that cannot drain; reimplantation helps when the cause is at the ureter–bladder connection.
- Megaloureter — a widened ureter, often with a narrow end where it joins the bladder, which can be reshaped and reimplanted.
- Vesicoureteral Reflux Nephropathy — kidney scarring caused by reflux and repeated infections; surgery aims to prevent further damage, not undo existing scars.
- Obstructive Uropathy — blocked urine flow, including ureteral strictures and injuries in adults, where the ureter may need to be reconnected to the bladder.
When to consult a specialist
If some of this sounds familiar, take a breath — most urinary symptoms have simple, treatable causes, and reflux in children often improves with time. A good first step is gentle and low-pressure: a urine test, a blood test for kidney function, and a kidney and bladder ultrasound can show quickly whether the kidneys are draining and working well. Your family doctor can arrange these. If anything points to a ureter problem, a urologist can explain the options — watchful waiting, antibiotics, an injection treatment or surgery — and which is right for you. Please seek urgent care for a high fever with severe side pain or repeated vomiting. You don’t have to work this out alone.
How a session works
- Before surgery. Your surgeon reviews imaging — usually a renal and bladder ultrasound, a voiding cystourethrogram (VCUG), and sometimes a CT or MR urogram — plus routine pre-op blood and urine tests. You’ll get fasting instructions and, for children, guidance on preparing them for a hospital stay.
- Anesthesia. The procedure is done under general anesthesia — you or your child will be asleep throughout.
- Choosing the approach. Depending on age, anatomy, and the underlying cause, the surgeon operates open (a small lower-abdominal incision), laparoscopically, or with robotic assistance.
- Detaching and repositioning the ureter. The ureter is freed from its original opening in the bladder. The surgeon creates a new submucosal tunnel — a channel between the bladder’s inner lining and its muscle — angled so the muscle compresses it properly during urination.
- Reattaching. The ureter is drawn through the new tunnel and stitched into place with dissolvable sutures. If both ureters need correction, the second side is repaired the same way.
- Bridging longer gaps (adults). When a segment of ureter has been lost — to injury, a stricture, or tumor removal — the surgeon may add a psoas hitch (fixing the bladder to the psoas muscle so it reaches higher) or a Boari flap (a tube fashioned from bladder tissue) to reconnect without tension on the new join.
- Drainage and closure. A temporary ureteral stent or a bladder (Foley) catheter is placed to keep urine draining while the join heals; a small drain may sit near the incision. The bladder, and any abdominal incision, are then closed.
Session duration
2–3 hours
recorded for this treatment
Cost verify
$8500–$28000
indicative range
Anesthesia
General
recorded for this treatment
Remember: The exact steps, duration and preparation can vary with your indication, health and care setting. Confirm the current plan with your treating team.
Benefits
The main aim of ureteral reimplantation is to give urine a safe, one-way route from the kidney to the bladder. For most people that means fewer infections, a calmer urinary tract, and one less worry about long-term kidney health.
- Urine flows the right way. The new tunnel works as a valve, so urine can’t back up toward the kidney, or it drains freely where it was blocked.
- Fewer kidney infections. Trials in children with reflux have shown fewer fevers with urinary infection after surgery, which means fewer sick days, hospital visits and courses of antibiotics.
- Protection for the kidneys. By stopping repeated infection and pressure on the kidney, surgery helps prevent new scarring. It cannot reverse scars that are already there, which is why timing and follow-up matter.
- Often no daily antibiotics. Many children can stop long-term preventive antibiotics once the repair has healed and scans look good.
- High success rates. Around 90% in one pediatric series and 95–98% in a long-term pediatric review; about 93% per ureter in a large adult series. Your own result depends on the cause and the technique, so ask your surgeon for figures that fit your case.
Risks & side effects
Ureteral reimplantation has risks and trade-offs to discuss with your care team. The information below comes from this treatment data.
Bleeding, urinary infection, urine leakage and bladder spasms; rarely, narrowing or return of reflux at the new connection. Risks are minimized by careful patient selection and experienced surgical teams.
Who it may not suit: Surgery may not be the first choice for children with low-grade reflux that is likely to settle on its own, for people with an active untreated urinary infection, a bleeding disorder, or a health condition that makes general anesthesia unsafe, or for children whose bladder and bowel habits have not yet been treated — guidelines advise addressing these first where possible. These are general cautions, not a personal verdict. A qualified clinician must assess your full medical picture before recommending or delaying treatment.
Common side effects are usually mild and temporary, and most ease over one to four weeks:
- Blood in the urine. Pink or light-red urine is expected for several days, up to about two weeks. Tell your team if it turns dark, or if clots appear.
- Bladder spasms and cramping. These feel like sudden lower-belly cramps, especially while a catheter or stent is in place; spasm medicine helps.
- Frequent, urgent or burning urination. The healing bladder is irritable and settles as the stent or catheter comes out.
- Soreness and tiredness. Pain at the incision, a sore throat after the breathing tube, and nausea from anesthesia usually pass within days.
- Infection. A urinary infection or a wound infection can occur, and is treated with antibiotics.
What happens during & after
Immediately after surgery, you or your child is moved to a recovery room to wake from anesthesia under close monitoring. It’s common to feel groggy, mildly nauseated, or have a sore throat if a breathing tube was used. Pain and bladder-spasm medication are given as needed.
Over the following one to a few days in hospital:
- IV fluids continue until eating and drinking normally
- The catheter stays in for one to several days to protect the healing repair
- A ureteral stent, if placed, may stay in for one to a few weeks and is usually removed in a short outpatient procedure
- The wound drain, if used, is typically removed before discharge
- Nurses monitor urine output, incision healing, and pain control
Most children go home within two to four days; adults having more complex reconstruction (for example with a psoas hitch or Boari flap) may need a slightly longer stay. Your care team will confirm the exact timeline for your situation before discharge.
Possible complications
Serious problems are uncommon, and surgical teams plan follow-up specifically to catch them early. Knowing what they are helps you recognize them quickly:
- Urine leak. Urine can seep from the new connection (urinary extravasation) in the first days. It often settles with a catheter or stent left in a little longer, and sometimes needs a drain or a further procedure.
- Narrowing or blockage at the new join. In one small long-term pediatric study, about 7.5% of repaired kidney units developed an obstruction, all within eight months and all after the Politano–Leadbetter technique. It can show up as flank pain, fever or swelling of the kidney on ultrasound.
- Reflux that returns or does not fully resolve. A repeat scan will show whether the valve is working; if it is not, an injection treatment or repeat surgery may be discussed.
- Blood clots. Clots in the leg veins, which can rarely travel to the lungs, are a risk after any operation; early walking and hydration lower it.
- Compartment syndrome. Very rarely, prolonged positioning during laparoscopic or robotic surgery raises pressure in a limb. Teams monitor for it.
- Injury to nearby organs or vessels. Uncommon, and more likely in complex adult re-operations after earlier surgery or radiation.
- Repair that needs revision. After complex adult reconstruction, such as a psoas hitch, most patients in a small series needed no further treatment, but a few, mainly those with cancer, did.
Remember:
New or severe symptoms require prompt medical advice. Do not wait for a routine appointment if you feel seriously unwell.
Recovery
Recovery after ureteral reimplantation is steady rather than fast: the first week is the most uncomfortable, most people feel much more like themselves by two weeks, and full activity returns after about a month. Your surgeon’s advice takes priority over the general timeline below.
In the hospital. Most children stay two to four days; adults with more complex reconstruction may stay a little longer. Before discharge, staff check that you can pass urine comfortably, that pain is controlled with oral medicine, and that you understand how to care for a catheter or stent if one is still in place.
At home
- Catheter and stent. The catheter is usually removed within a few days, often before or shortly after discharge. A ureteral stent, if placed, typically stays for one to a few weeks and is taken out in a short outpatient procedure.
- Urine and discomfort. Blood-tinged urine, mild burning and bladder spasms are expected for one to two weeks and ease steadily. Take pain and spasm medicine as prescribed; strong painkillers are rarely needed beyond the first few days.
- Drinking and bathroom habits. Plenty of fluids and regular, unstrained bowel movements help the bladder heal and keep infections away.
Getting back to normal
- School and work. Most children return to school or daycare within one to two weeks. Adults with desk-based jobs often manage a similar timeline; physical jobs need surgeon clearance.
- Activity. Rest and light walking at first. Avoid heavy lifting, strenuous exercise, swimming, cycling and contact sports for about three to six weeks, or until your surgeon agrees, depending on the approach and age.
Follow-up. A kidney and bladder ultrasound, and sometimes a repeat VCUG or renal scan, is usually done at about one to three months to confirm the repair is working. Further visits then continue on a schedule your urologist sets, often over one to two years, to check kidney growth, infections and kidney function.
Clinics offering Ureteral reimplantation
Verified kidney centres linked to this treatment in the KidneyGlobal directory.
University Hospital
Urologic Oncology & Robotic Surgery
ISO 9001European Urology Boardda Vinci Robotic Center
✓ 24/7 ER✓ ICU✓ Insurance
Academic Medical Center
Minimally Invasive Urologic Surgery
Joint CommissionNCI Cancer CenterRobotic Surgery Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Academic Medical Center
Kidney Transplantation
Joint CommissionUNOS CertifiedLiving Donor Excellence
✓ 24/7 ER✓ ICU✓ Insurance
Good questions
Most Common Questions
Is ureteral reimplantation only done in children?
No. It is most common in children with vesicoureteral reflux, but adults need it too — most often after a ureter is injured during pelvic surgery, or narrowed by stones, endometriosis, radiation or a tumor.
Does reflux always need surgery?
No. Many children outgrow low-grade reflux, and doctors often start with monitoring and, in some cases, low-dose preventive antibiotics. Surgery is usually considered when infections keep breaking through, reflux is high-grade, or the kidneys show scarring. An endoscopic injection is another option your urologist may discuss.
How long does the operation take, and how long is the hospital stay?
The surgery usually takes about two to three hours. Most children go home after two to four days; adults may stay a little longer if the repair is complex.
How successful is it?
Success is high — around 90% in one pediatric series and 95–98% in a long-term review, with similar results for adults treated for strictures. Results depend on the cause and technique, so ask your surgeon what to expect in your case.
Will I or my child still need antibiotics afterwards?
Often not for the long term. Many children can stop daily preventive antibiotics once the repair has healed and follow-up scans look good, but your urologist decides when, and short courses are still used to treat any infection that appears.
Is it painful, and when can normal life resume?
Expect soreness and bladder spasms for the first week or two, which medicine controls well. Most children are back at school within one to two weeks, and heavy lifting and sport usually wait three to six weeks — follow your surgeon's advice.
Sources
- Management and Screening of Primary Vesicoureteral Reflux in Children (2010, amended 2017)American Urological Association
- Ureteral reimplantationTop Doctors UK
- Ureteric reimplantation for reflux (patient information)Belfast Health and Social Care Trust
- Late surgical complications and long-term kidney outcomes following ureteral reimplantation for high-grade VUR and primary obstructed megaureterPediatric Surgery International (Springer, 2025)
- Lessons from 151 ureteral reimplantations for postcystectomy ureteroenteric stricturesUrologic Oncology (2017); University of Iowa
- Versatility of the adult psoas hitch ureteral reimplantationJournal of Urology (American Urological Association, 1997)
- Adult iatrogenic ureteral injury and stricture – incidence and treatment strategiesAsian Journal of Urology (2018), via PubMed Central
- Urinary reflux surgery (cost comparison, open vs robotic)Healthline