Pediatric Ureteral Reimplantation Anesthesia - AnethAssist

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Pediatric Ureteral Reimplantation — What it is

Extravesical, intravesical, combined, laparoscopic, or robotic reimplantation of one or both ureters into the bladder.

Pediatric Ureteral Reimplantation — Common indications

High-grade or progressive VUR, renal scarring, persistent reflux, breakthrough UTI, poor medical compliance, obstructive megaureter, or ureterocele.

Pediatric Ureteral Reimplantation — Position

Supine for open repair; supine with legs splayed and Trendelenburg for robotic repair.

Pediatric Ureteral Reimplantation — Surgical access

Pfannenstiel or low-midline extraperitoneal exposure; repair may be intravesical, extravesical, combined, laparoscopic, or robotic after cystoscopy.

Pediatric Ureteral Reimplantation — Typical duration

Approximately 1.5 h open and 3-5 h robotic.

Pediatric Ureteral Reimplantation — Expected blood loss

Minimal.

Pediatric Ureteral Reimplantation — Pain and stimulation

Pain score 7 open and about 4 robotic.

Pediatric Ureteral Reimplantation — Anesthetic options

GETA with optional caudal or epidural analgesia; coordinate catheter planning because neuraxial analgesia increases urinary-retention risk.

Pediatric Ureteral Reimplantation — Airway

Standard pediatric airway; use ETT for robotic pneumoperitoneum, Trendelenburg, prolonged surgery, or limited access after docking.

Pediatric Ureteral Reimplantation — IV and blood preparation

One pediatric IV usually suffices; add access for long robotic, bilateral, renal-failure, or complex reconstruction cases.

Pediatric Ureteral Reimplantation — Monitoring

Standard monitors and urinary catheter; add arterial pressure, hematocrit, blood glucose, or ABG for long surgery, blood loss, or renal dysfunction.

Pediatric Ureteral Reimplantation — Ventilation and physiology

Controlled ventilation is required robotically; pneumoperitoneum and Trendelenburg impair ventilation and venous return. Limit nitrous oxide when bowel distention obstructs exposure.

Pediatric Ureteral Reimplantation — Regional options

Caudal or epidural analgesia reduces postoperative medication needs but increases urinary retention; determine the surgeon's catheter plan before block placement.

Pediatric Ureteral Reimplantation — Positioning risks

Lower-extremity nerve or pressure injury, sliding in Trendelenburg, limited access after docking, ETT movement, and inadequate securement during table tilt.

Pediatric Ureteral Reimplantation — Major intraoperative risks

Bleeding, bladder leak, ureteral obstruction, persistent reflux, insufflation-related hemodynamic effects, trocar or thermal injury, and positioning injury.

Pediatric Ureteral Reimplantation — Major postoperative risks

Infection under 3%, bleeding under 3%, urinary retention under 5% unilateral or 8-10% bilateral, ureteral obstruction, persistent reflux, and bladder spasm.

Pediatric Ureteral Reimplantation — Postoperative destination

PACU to ward; most open patients leave within 48 h, with catheter, stent, and bladder-spasm management as required.

Pediatric Ureteral Reimplantation — Critical communication

Confirm open versus robotic approach, unilateral or bilateral repair, cystoscopy, stents, catheter, drain, antibiotic plan, regional analgesia, and retention strategy.

Pediatric Ureteral Reimplantation — Fast pearl

Ask whether a urethral catheter will remain before choosing neuraxial analgesia; postoperative retention is difficult to diagnose after bladder surgery.