Ureteral Re-Implantation
Ureteral reimplantation (ureteroneocystostomy) is a surgical procedure in which the ureter is detached from its native insertion into the bladder and re-anastomosed at a new site in the bladder wall. Typically used to treat severe vesicoureteral reflux.
Anesthetic Considerations:
Length: 2-4 hours but duration can vary significantly
GA with ETT + caudal vs
Analgesia: Epidural or caudal analgesia is frequently used. Pain sources are abdominal incision (mediated by T11-L2) as well as visceral blader spasm (mediated by S2-S4 parasympathetic + T11-L2 sympathetic fibers)
Some evidence suggesting caudal catheter is the superior technique over high lumbar epidurals thought to be due to better sacral coverage. [1]
Ketorolac very effective in reducing postoperative bladder spasm.[2]
Access: 1 -2 PIV
Maintenance: inhalational or TIVA appropriate
Neuromuscular blockade: as needed
Blood loss: In children typically minima 0 to 50ccl. Adults more substantial 5 to 500cc
- ↑ Sommerfield, David; Ramgolam, Anoop; Barker, Andrew; Bergesio, Ric; von Ungern‐Sternberg, Britta S (2016-04-07). "Epidural insertion height for ureteric reimplant surgery; does location matter?". Pediatric Anesthesia. 26 (10): 951–959. doi:10.1111/pan.12895. ISSN 1155-5645.
- ↑ Park, John M.; Houck, Constance S.; Sethna, Navil F.; Sullivan, Lorna J.; Atala, Anthony; Borer, Joseph G.; Cilento, Bartley G.; Diamond, David A.; Peters, Craig A.; Retik, Alan B.; Bauer, Stuart B. (2000-07). "Ketorolac Suppresses Postoperative Bladder Spasms After Pediatric Ureteral Reimplantation:". Anesthesia & Analgesia. 91 (1): 11–15. doi:10.1097/00000539-200007000-00003. ISSN 0003-2999. Check date values in:
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