Robotic Ureteric Reimplantation
Robotic ureteric reimplantation (ureteroneocystostomy) is a surgical procedure that creates a new connection between the ureter and bladder when the lower portion of the ureter is damaged, strictured, or diseased. This may be necessary due to strictures, injuries, tumours, endometriosis, or radiation damage affecting the ureter. Dr Brendan Dias performs this complex reconstructive procedure using the da Vinci robotic surgical system. The robotic platform provides enhanced 3D visualisation, precise instrument control, and the ability to perform delicate suturing through small keyhole incisions. The procedure may involve various techniques depending on the length of ureter that needs to be replaced, including direct reimplantation, psoas hitch (elevating the bladder to the psoas muscle to bridge the gap), or Boari flap (fashioning a tube from bladder tissue to extend to the ureter). Dr Dias selects the optimal approach based on individual patient anatomy.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (Urology), DrNB (Urology), FRCS (Urol), FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- 90-95% success rate for restoring normal ureteric drainage
- Minimally invasive approach with 4-5 small keyhole incisions
- Significantly reduced postoperative pain compared to open surgery
- Shorter hospital stay of 2-3 nights in most cases
- Faster return to normal activities (3-4 weeks vs 6-8 weeks)
- Enhanced precision for complex reconstructive suturing
- Incorporates anti-reflux mechanism to prevent urine backflow
- Suitable for strictures, injuries, and lower ureteric tumours
The Procedure
Robotic ureteric reimplantation is performed under general anaesthesia with the patient positioned supine or in low lithotomy position. Four to five robotic ports are placed through small incisions. The ureter is carefully dissected and the diseased or damaged segment is identified and excised. The healthy proximal ureter is mobilised to ensure it will reach the bladder without tension. Depending on the gap length, different techniques may be employed. For short defects, direct reimplantation is performed. For longer defects, a psoas hitch (suturing the bladder to the psoas muscle) or Boari flap (creating a bladder tube) provides additional length. A submucosal tunnel is created in the bladder wall to provide an anti-reflux mechanism. The ureter is passed through this tunnel and secured with fine absorbable sutures. A ureteric stent is placed to protect the repair. The bladder is closed in layers and a urinary catheter is left in place. The procedure typically takes 2-4 hours depending on complexity.
Who Is a Candidate?
Robotic ureteric reimplantation is suitable for patients with distal ureteric strictures not amenable to endoscopic treatment, those with ureteric injuries from previous surgery requiring reconstruction, patients with lower ureteric tumours requiring segmental resection, cases of vesicoureteral reflux requiring surgical correction, patients with endometriosis or radiation damage affecting the ureter, those with failed previous endoscopic treatments (balloon dilation, stenting), candidates seeking minimally invasive reconstruction with faster recovery, and patients with good overall health to tolerate general anaesthesia.
Recovery
Hospital stay is typically 2-3 nights following robotic ureteric reimplantation. A urinary catheter remains in place for 7-14 days to allow the bladder and ureteric anastomosis to heal. Light activities including walking are encouraged from day one; driving can resume after catheter removal. The internal ureteric stent may cause some urinary frequency, urgency, or mild discomfort. Return to work typically occurs within 2-3 weeks for desk jobs; physical work requires 4-6 weeks. The stent is removed at 4-6 weeks via a brief cystoscopy procedure. Follow-up imaging confirms successful repair and normal kidney drainage.
Risks & Considerations
As with any surgical procedure, robotic ureteric reimplantation carries some risks including bleeding requiring transfusion (rare), urine leak at the anastomosis site, stricture or narrowing of the new connection (5-10%), vesicoureteral reflux (urine backflow to kidney), injury to surrounding structures including bowel or blood vessels, stent-related symptoms (frequency, discomfort) which are temporary, conversion to open surgery if needed (rare), and blood clots in legs (DVT) or lungs (PE).