Problems After Reimplantation: Obstruction, Reflux, Bladder Spasm

In the first week, blood-tinged urine, bladder spasm, frequent and burning urination, tenderness around the incision, and poor appetite are the normal traces of surgery; all resolve on their own. Real problems, on the other hand, are rare, and most are caught early through the first follow-up ultrasound or through symptoms.

Some swelling in the newly reimplanted ureter's tunnel through the bladder wall in the first days is natural and can temporarily slow urine flow. This appears on the first follow-up ultrasound as mild-to-moderate kidney dilation (hydronephrosis); in most cases it resolves within a few weeks, at most a few months, and needs no treatment.

Reflux persisting on the same side despite surgery is rare (approximately 2–5% in the literature). Causes include an insufficiently long tunnel, untreated bladder-bowel dysfunction (BBD), an underlying high-pressure bladder such as neurogenic bladder, and very wide ureters. Low-grade residual reflux usually resolves over time and does not require intervention.

When the extravesical Lich-Gregoir technique is applied to both sides in the same session, temporary involvement of the nerve fibers on the back-lateral surface of the bladder can cause some children to have difficulty voiding or incomplete bladder emptying after surgery. This rate varies in the literature by center and technique; it has decreased significantly with nerve-sparing dissection.

• This is usually temporary: the bladder is emptied with a catheter or clean intermittent catheterization for a period ranging from a few days to a few weeks, and voiding resolves on its own. A lasting voiding problem is very rare. Our doctors discuss this risk openly in the pre-surgery consultation for bilateral cases and choose the technique (Cohen, single-session extravesical, or two sessions) accordingly.

Wound infection is rare; it presents with increasing redness, warmth, discharge, and fever around the incision, and mostly resolves with oral antibiotics. A urinary tract infection can occur during the catheter period and in the first weeks; a distinction is made between an afebrile bladder infection (cystitis) and a febrile kidney infection (pyelonephritis).

• Fever of 38°C or higher, chills, flank pain: same-day evaluation.
• Progressive kidney dilation on ultrasound: a drainage scan is used to check for obstruction.
• After a febrile infection: a new scar is checked for with DMSA 4–6 months later.
• In recurrent infection after surgery, BBD (constipation, delayed voiding, retained urine) is always checked for.

• A febrile UTI after surgery is a warning sign to check for obstruction or persistent reflux, but on its own does not mean the surgery has failed; in many children the cause is bladder-bowel dysfunction (BBD) or constipation. A culture is taken and treatment started, obstruction is ruled out with ultrasound, and a study is planned if needed.