Pediatric Transureteroureterostomy Anesthesia - AnethAssist

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Pediatric Transureteroureterostomy — What it is

End-to-side anastomosis of a problematic ureter to the contralateral ureter, with recipient-ureter reimplantation when required.

Pediatric Transureteroureterostomy — Common indications

Failed ureteral reimplantation, urinary undiversion, distal ureteral trauma, or drainage into a neobladder or augmented bladder.

Pediatric Transureteroureterostomy — Position

Supine.

Pediatric Transureteroureterostomy — Surgical access

Midline or Pfannenstiel incision with peritoneal entry; the affected ureter crosses anterior to the great vessels for end-to-side anastomosis.

Pediatric Transureteroureterostomy — Typical duration

Approximately 3 h.

Pediatric Transureteroureterostomy — Expected blood loss

Minimal.

Pediatric Transureteroureterostomy — Pain and stimulation

Pain score 10.

Pediatric Transureteroureterostomy — Anesthetic options

GETA with active warming and optional epidural or caudal analgesia; adjust drugs and fluids for renal dysfunction.

Pediatric Transureteroureterostomy — Airway

Use a secured pediatric ETT; consider modified RSI when renal failure causes reflux or delayed gastric emptying.

Pediatric Transureteroureterostomy — IV and blood preparation

One upper-extremity IV usually suffices; add access for complex reconstruction, renal dysfunction, or unexpected hemorrhage.

Pediatric Transureteroureterostomy — Monitoring

Standard monitors and urinary catheter; add arterial pressure, electrolytes, ABG, or hematocrit for renal dysfunction, prolonged surgery, or instability.

Pediatric Transureteroureterostomy — Ventilation and physiology

Use controlled ventilation and limit bowel distention when intraperitoneal exposure is difficult.

Pediatric Transureteroureterostomy — Regional options

Epidural or caudal analgesia may reduce opioid use when coagulation is normal but can increase urinary retention.

Pediatric Transureteroureterostomy — Positioning risks

Pressure injury, eye injury, ETT movement, hypothermia, and catheter or stent obstruction during prolonged supine reconstruction.

Pediatric Transureteroureterostomy — Major intraoperative risks

Ureteral injury, bleeding, bowel or great-vessel injury, urinary leak, dysrhythmia, electrolyte disturbance, and injury to the recipient ureter.

Pediatric Transureteroureterostomy — Major postoperative risks

Bleeding under 5%, infection under 5%, ileus under 5%, urinary fistula under 5%, and renal-failure-related metabolic complications when present.

Pediatric Transureteroureterostomy — Postoperative destination

PACU to ward; escalate for renal failure, major reconstruction, respiratory compromise, or hemodynamic instability.

Pediatric Transureteroureterostomy — Critical communication

Confirm recipient-ureter reimplantation, neobladder or augmentation involvement, stents, catheter, drain, renal function, antibiotics, and postoperative urinary-drainage plan.

Pediatric Transureteroureterostomy — Fast pearl

The recipient ureter may also require reimplantation into a neobladder or augmented bladder.