You have been told your child needs an operation called a reimplant.This may have been explained to you. Hopefully this booklet will answer any questions that you may have about your child’s surgery and stay in hospital.
This operation is usually done because your child has vesico-ureteric reflux. This can occur on either side or both sides. This means that when your child’s bladder contracts urine passes back to the kidney. Normally the ureter closes when the pressure in the bladder rises and you pass urine through the urethra. The reflux may have been responsible for frequent urine infections, which can damage one or both kidneys.
This operation involves moving the ureter and repositioning it at a different angle into the bladder to prevent reflux from occurring.
Your child will be admitted to hospital the day before surgery. A nurse and a doctor will see them. Blood and urine tests will be required, a special cream called EMLA or AMETOP (local anaesthetic) will be applied to the back of their hand to make blood taking as painless as possible.
The theatre nursery nurse will prepare your child for the theatre by using play. Later on’ the anaesthetist will see you.
After you have seen the surgeon and consented to your child’s operation you may take your child home, and return the next morning.
Your child’s stay in hospital will be approximately seven to ten days, however, occasionally it may be necessary to stay longer.
Your child will need to bring in night and daytime clothing (baggy tee shirts and shorts are advisable) toiletries and any special toys that they may want. Accommodation may be available if you want to stay in hospital with them. You may be able to use a temporary bed on the ward.
Your child should not eat anything for six hours before theatre (four hours for milk dependant babies) but they should be able to have a last clear drink two hours before surgery although this drink should not contain milk.
An hour before theatre your child should be dressed in either night-gown or pyjamas of their own, providing they can open down the front, or if wished a hospital theatre gown will be provided.
EMLA or AMETOP cream will then be applied again so the anaesthetic can be administered through the needle in the hand.
When going to theatre a member of staff will accompany your child. Your child can ride on a trolley or walk.
The operation will take 1-3 hours depending on whether one or both sides are operated on.
However, your child may be away from the ward for up to 4 hours as children take a while to recover from the anaesthetic.
Every child is different. Some children are awake when they return but others will sleep for several hours.
The wound will be in the area of the bikini line (see diagram). There will be a thin cut that will be covered by a clear dressing, and there may be some oozing underneath the dressing.
The operation will leave a scar but this will fade with time so it will not be so obvious.
There will be a drain into the wound that will be removed after one week and there will be no visible stitches.
The child will also have a catheter into the bladder, and possibly small tube called a stent into the ureter.
We aim to relieve pain or discomfort as much as possible. Children may be given an injection into their back which will give them a degree of numbness from the waist down (this is called an epidural). They will also have a pain killing diamorphine infusion (drip) which will run continuously and will be adjusted by the nursing staff to keep your child comfortable.
Your child will be able to drink within a few hours of theatre, but anaesthetics can make some children feel sick.
There will be an intravenous infusion (drip) running into a vein in their hand or foot to prevent them becoming dehydrated. It will be removed as soon as your child is drinking normally. Your child will be able to eat when they can tolerate fluids properly, probably the next day.
He/she will have a catheter in place (tube which drains the bladder – see diagram). This catheter may be in the urethra (tube which leads from the bladder to the outside) or may be inserted directly into the bladder through the abdomen. Either way the urine will be heavily blood – stained initially so do not be alarmed, this is completely normal and will clear over the following days. The catheter will be removed after 6 -8 days.
Your child will have small tubes called stents coming out of the wound which are attached to drainage bags: they drain urine from the ureters so protecting the operation site of the bladder. Stents are not necessary in all patients and are removed after 6 days, unless in cases where the ureter was reduced in size (tapered); then it could be several days longer.
It is important to prevent constipation so lactulose or similar medicine will be given.
You can be involved as much as possible in the care of your child during which you will have support from the nursing staff. It is also important that you prevent your child from pulling any of the tubes that they have in place, as they are all important to the success of the surgery.
Your child may be well enough to go back to school after a couple of weeks, although they will need to avoid strenuous physical activities to allow the would to heal inside and out.
You will be seen in children’s outpatients approximately six weeks after discharge home. It may be necessary to continue on antibiotics for some time to prevent any further urine infections occurring while recovering from surgery (further prescriptions should be obtained from your GP). Your child will have an ultrasound scan several weeks after surgery.
The aim of antireflux surgery is to prevent your child from getting urine infections which could seriously damage their kidneys. This surgery is successful in more than 9 out of 10 patients.
Obstruction to the ureter, persistent reflux into the ureter despite operation and recurrent infection occur in less than 2 out of 100 operations.
Antireflux surgery does not improve an already scarred kidney and careful follow-up is necessary. This is likely to be by the nephrologist (children’s kidney specialist).
NKF Controlled Document No. 279, Reimplantation of Ureters, written 11 March 2008. Last reviewed 11 March 2008.
Content compiled by members of the Children and Young People's Kidney Unit, City Hospital, Nottingham NG5 1PB.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
Page created: 17 March 2008
Last updated: 17 March 2008
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