Ureteral reimplantation
Ureteral reimplantation is an operation that stops urine from flowing backward from the bladder up toward the kidney (vesicoureteral reflux). The surgeon reattaches the ureter to the bladder through a longer tunnel in the bladder wall, which works as a one-way valve.
Also called ureteral reimplant, ureteroneocystostomy, reflux surgery, VUR surgery, vesicoureteral reflux surgery, Cohen reimplant, cross-trigonal reimplant, Lich-Gregoir repair
- Where
- Children's hospital operating room
- Anesthesia
- General anesthesia, usually with a caudal or epidural numbing block
- Time in the room
- About 2 to 4 hours
- Hospital stay
- Usually 1 to 2 nights
- Going home with
- A bladder catheter, usually removed before going home
- Back to normal
- About 1 to 2 weeks
- Back to work
- School or daycare in about 1 to 2 weeks
Overview
Normally urine flows one way: from the kidneys, down the ureters (the tubes that drain each kidney), and into the bladder. Where each ureter enters the bladder, it runs through a short tunnel in the bladder wall. When the bladder fills or squeezes, the tunnel is pressed flat like a valve, so urine cannot go back up. In vesicoureteral reflux, or VUR, the tunnel is too short, and urine flows backward toward the kidney.
Reflux itself does not cause symptoms. The concern is that bacteria from a bladder infection can travel up to the kidney and cause a kidney infection with fever, and repeated kidney infections can scar the kidney. Reflux is graded from 1 (mild) to 5 (severe). Many children, especially with lower grades, outgrow reflux as they grow, so treatment often starts with watching, treating constipation and bladder habits, and sometimes a daily low-dose antibiotic.
Ureteral reimplantation fixes the valve directly by giving the ureter a new, longer tunnel. It is the most reliable treatment for reflux, curing it in about 95 to 98 of every 100 ureters with open surgery. It can be done through a small, low incision (open surgery) or with robotic keyhole surgery. Your child's surgeon will explain which approach fits your child best.
The parts of your body involved
Each kidney makes urine, which flows down its ureter into the bladder. The ureters enter the back of the bladder at an area called the trigone. Inside the bladder wall, each ureter travels through a tunnel before opening into the bladder. A long tunnel makes a good valve. In reflux, the tunnel is short, and urine can rush back up when the bladder squeezes.
- Kidneys
Two bean-shaped organs that filter the blood and make urine.
- Ureters
Thin tubes that carry urine from each kidney down to the bladder.
- Bladder
The stretchy bag that stores urine until your child pees.
- Trigone
A triangle-shaped area on the floor of the bladder where both ureters open.
- Ureter opening
The small slit where each ureter empties into the bladder. In reflux it is often wider and sits in a short tunnel.
- Tunnel in the bladder wall
The path the ureter takes through the bladder wall. Making it longer is the heart of the operation.
Why it’s done
Most children with reflux never need surgery. Reimplantation is considered when reflux keeps causing problems or is unlikely to go away on its own.
- Kidney infections despite treatment
If your child keeps getting kidney infections with fever while on a daily antibiotic, AUA guidelines suggest moving to a procedure to correct the reflux.
- New or worsening kidney scarring
Scans showing new damage to the kidney are a strong reason to fix the reflux.
- Severe reflux
Grades 4 and 5 are less likely to go away on their own, especially in older children.
- Reflux that persists as your child grows
Reflux that is still present after years of follow-up is less likely to resolve.
- Family preference
Some families prefer a definite fix over years of antibiotics and repeat X-ray tests.
Other options
- Watching and waiting
Many children outgrow reflux, especially grades 1 to 3. This means regular check-ups and ultrasounds, and prompt treatment of any fever.
- Daily low-dose antibiotic
A small daily dose to prevent infections. In a large U.S. trial (RIVUR), it cut repeat urinary infections by about half, though it did not reduce kidney scarring.
- Treating bladder and bowel habits
Constipation and holding urine make infections and reflux worse. Regular toilet times, plenty of water and treating constipation help many children.
- Endoscopic injection (Deflux)
Gel injected through a scope under the ureter opening. A short, same-day procedure with no incision, but less likely to cure the reflux than reimplantation.
Getting ready
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Weeks before
The week before
The day before and the morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
Your child falls asleep breathing anesthesia gas through a mask, often with a parent nearby. An IV is placed once your child is asleep, and an antibiotic is given.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Waking up
Your child will be groggy. The numbing block keeps the lower body comfortable for several hours, and sometimes longer with an epidural.
- Bladder spasms
Very common, especially after open surgery inside the bladder. Your child may have sudden cramps, pain at the tip of the penis or the genitals, and a strong urge to pee. Spasm medicine helps.
- Blood in the urine
Pink or red urine is normal for the first days.
- Catheter out
The catheter usually comes out after 1 to 2 days. The first pees may burn.
- Eating and moving
Drinks start soon after waking, and most children are walking around the next day.
- Going home
Usually after 1 to 2 nights. Robotic and outside-the-bladder repairs often need only one night.
At home
- Pain
Acetaminophen and ibuprofen, if allowed, on a schedule for the first few days. Older children may need a few doses of something stronger.
- Bladder spasms
Spasms can continue for a week or two. Keep giving spasm medicine as directed.
- Blood in the urine
Pink urine may come and go for a few weeks. Extra fluids help.
- Incision care
Keep the incision clean and dry. Most surgeons allow showers or sponge baths after a couple of days and tub baths after about a week. Follow your team's advice.
- Peeing habits
Your child may need to pee often for a few weeks. Encourage regular toilet times every 2 to 3 hours and relaxed, complete emptying.
- Bowels
Avoid constipation with fluids, fruit and fiber, and use a stool softener if your team suggests it. Constipation makes spasms and infections worse.
- Activity
Quiet play for the first week. School in 1 to 2 weeks. Avoid rough play, climbing and contact sports for about 3 to 4 weeks.
- Antibiotics
Some surgeons continue the daily antibiotic until the follow-up ultrasound; others stop it soon after surgery.
Recovery timeline
- Day 0Surgery
Your child wakes up comfortable with a catheter and a numbing block.
- Days 1 to 2Catheter out, home
Most children go home after 1 to 2 nights.
- Week 1Spasms ease
Bladder spasms and blood in the urine settle.
- Weeks 2 to 4Back to school
Normal routine returns, with rough play after about 3 to 4 weeks.
- 1 to 3 monthsFollow-up ultrasound
A kidney and bladder ultrasound checks for swelling that could mean blockage. Mild early swelling is common and usually settles.
- 3 to 6 monthsConfirming the result
Some surgeons repeat the VCUG to confirm the reflux is gone. Many skip it after open surgery because success is so high.
- Long termKidney health
Children with kidney scarring need blood pressure checks over the years. Girls who had reflux and scarring should tell their doctor during any future pregnancy.
What it feels like
For most families, the biggest surprise is the bladder spasms in the first days. Children usually bounce back quickly, often faster than their parents.
Deciding on surgery
Parents often go back and forth between surgery and waiting, and some feel guilty about the infections their child has had.
What helpsAsk about your child's grade, any scarring, and the chance of outgrowing it. Reflux is something a child is born with, and nothing you did caused it.
The morning of surgery
Anxiety, for parents and children alike.
What helpsBring comfort items, use simple honest words, and ask to stay until your child falls asleep.
Waking up
Children are groggy and usually comfortable at first. Older children may find the catheter strange or embarrassing.
What helpsExplain that the tube is temporary and will come out in a day or two.
Bladder spasms
Sudden, strong cramps. Children may cry, clutch their belly or genitals and feel they must pee right now, and urine or blood may leak around the catheter.
What helpsGive spasm medicine on schedule, use a warm pack on the lower belly for older children, and reassure them it will pass.
The first pee
Stinging, and some children are afraid and try to hold it.
What helpsEncourage drinking, let them sit and relax, and if your team allows, pee in a warm bath.
The first week home
Tiredness and pink urine that comes and goes.
What helpsRest, quiet play, plenty of fluids, and a stool softener if needed.
The follow-up ultrasound
Waiting for results can be stressful.
What helpsAsk when and how you will hear the results. Mild swelling of the kidney early on is common and usually settles.
How well it works
Success means the reflux is gone and, most importantly, your child stops getting kidney infections.
- High success rate
Open reimplantation cures reflux in about 95 to 98 of every 100 ureters. Robotic repairs can approach this in experienced hands, though reported results vary more between centers.
- Fewer kidney infections
Surgery lowers the risk of kidney infections with fever. Bladder infections can still happen, especially if constipation or holding habits continue.
- Checking the result
A kidney ultrasound after surgery, and in some cases a repeat VCUG.
- Kidney health over time
Existing scars do not go away, but new scarring from reflux becomes much less likely.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Very common in the first days, and they can last a week or two.
Common for days to a few weeks.
Urgency and frequency for a few weeks while the bladder heals.
Mostly in the first few days.
Less common
Bladder infections can still occur after surgery, especially with constipation.
The reflux may not be fully fixed. Some cases improve on their own; others need another procedure.
After a one-sided repair, reflux sometimes appears on the other side. It often goes away on its own.
After a two-sided repair done from outside the bladder, some children need a catheter for a short time. Emptying nearly always recovers.
Rare
Swelling or scarring at the new tunnel can block urine flow. It is often temporary but may need a stent or repeat surgery.
Usually heals with a catheter or drain left a little longer.
Injury to the bowel, blood vessels, or in boys the tube that carries sperm, is rare.
Rare.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher
- Pain in the side or back, especially with vomiting
- No urine for 8 hours, or straining without passing urine
- Bright red urine with clots, or bleeding that does not clear with extra fluids
- Vomiting or not able to keep fluids down
- Redness, swelling, pus or opening of the incision
- Swelling of the belly or belly pain that keeps getting worse
Questions to ask your surgeon
- What grade of reflux does my child have, and is there any kidney scarring?
- What are the chances my child will outgrow it without surgery?
- Why do you recommend surgery now rather than waiting or antibiotics?
- How does reimplantation compare with an injection (Deflux) for my child?
- Open or robotic, and inside the bladder or outside? Why?
- How many of these do you perform each year, and what are your results?
- How long will my child be in the hospital, and how will you control bladder spasms?
- Will my child need antibiotics after surgery, and for how long?
- Which follow-up tests will be needed, and when?
- If both sides reflux, will both be fixed?
- What should we do about constipation and toilet habits?
Words you may hear
- Vesicoureteral reflux (VUR)
- Urine flowing backward from the bladder up the ureter toward the kidney.
- Ureter
- The tube that carries urine from a kidney to the bladder.
- Trigone
- The triangle-shaped area on the bladder floor where the ureters open.
- Ureteral orifice
- The opening of the ureter inside the bladder.
- Reflux grade
- A scale from 1 (mild) to 5 (severe) describing how far and how much urine flows back.
- VCUG
- Voiding cystourethrogram: an X-ray taken as the bladder fills with dye and empties, to show reflux.
- DMSA scan
- A nuclear medicine scan that shows kidney scarring.
- Pyelonephritis
- A kidney infection, usually with fever.
- Kidney scarring
- Permanent damage to part of the kidney, often from repeated infections.
- Intravesical
- Done from inside the bladder.
- Extravesical
- Done from outside the bladder, without opening it.
- Bladder and bowel dysfunction
- Constipation and holding or incomplete emptying of urine, which raise infection risk.
- Bladder spasm
- A sudden, painful squeeze of the bladder muscle after surgery.
- Antibiotic prophylaxis
- A small daily dose of antibiotic to prevent infections.
Common questions
Will my child outgrow reflux?
Many do, especially with grades 1 to 3 and in younger children. Higher grades are less likely to resolve. Your urologist can estimate the chances for your child.
Did we miss something that caused the kidney infection?
Reflux is usually found only after a first infection with fever. It is something a child is born with. Reflux can run in families, so brothers and sisters are sometimes checked.
Is robotic surgery better than open surgery?
Robotic surgery uses smaller cuts and may mean a shorter stay. Open surgery has the longest track record and very high success. Results depend most on the surgeon's experience with the approach.
Will my child still get infections?
Kidney infections with fever become much less likely. Bladder infections can still happen, so good toilet and bowel habits remain important.
Can reflux come back after surgery?
It is uncommon once the repair has healed and follow-up shows the reflux is gone.
Will this affect my child's future health?
Most children go on to normal lives. If there was kidney scarring before surgery, your child will need occasional blood pressure and kidney checks as they grow.
Sources this page draws on
- American Urological Association (AUA), Management and Screening of Primary Vesicoureteral Reflux in Children: AUA Guideline (2010)
- New England Journal of Medicine, Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux (RIVUR trial) (2014)
- European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU), Guidelines on Paediatric Urology
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Vesicoureteral Reflux (VUR)
- Urology Care Foundation, Vesicoureteral Reflux (VUR)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.