Prof. Dr. Emel Akoğlu
UrologyVerified
- 57+years exp.
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Kidney & Bladder
Robotic ureteral reimplantation
What robotic ureteral reimplantation is, when the ureter is re-attached to the bladder for reflux, blockage or injury, how a robotic system is used through small incisions, what the evidence says compared with open surgery and endoscopic options, approximate costs in Turkey against the UK, US and Germany, stent and catheter recovery, risks and how to check a hospital.
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Prof. Dr. Zerrin Biçik Bahçebaşı
UrologyVerified
- 37+years exp.
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What is robotic ureteral reimplantation and how does it work?
Robotic ureteral reimplantation is an operation that detaches a ureter, the tube that carries urine from the kidney to the bladder, and attaches it again to the bladder in a new, protected position. The surgeon sits at a console and controls robotic instruments passed through a few small incisions in the lower abdomen, guided by a magnified three-dimensional camera. The robot is useful because the ureter and bladder lie deep in the pelvis, where fine stitching is difficult through a small opening. Hospitals in Turkey perform the operation with a da Vinci system, in adults and, with a paediatric urologist, in children.
This guide explains which conditions it treats, what the evidence says, what it costs compared with the UK, US and Germany, what the stent and catheter mean for recovery and how to check a hospital. Other urological operations are listed in our urology treatments in Turkey hub.
Which conditions need ureteral reimplantation?
The operation is used when the junction between ureter and bladder is not working. The commonest reasons are vesicoureteral reflux (urine flowing back up the ureter towards the kidney, especially in children with repeated kidney infections), a narrowing or blockage of the lower ureter, an injury to the ureter during previous surgery or radiotherapy, and an abnormal ureter that enters the bladder in the wrong place. Left untreated, reflux or blockage can damage the kidney over time, so the aim is to protect kidney function and stop infections.
Not every case needs surgery. Mild reflux in children often improves with growth and low-dose antibiotics, and some narrowings can be treated with a stent or balloon. Your urologist will confirm the cause with ultrasound, a bladder X-ray (cystogram), a kidney function scan or a CT scan before recommending reimplantation.
Does robotic ureteral reimplantation work, and how does it compare with open surgery?
Yes. Reimplantation, whether open or robotic, has a high success rate for stopping reflux and relieving blockage when the technique is chosen well. For robotic surgery the evidence consists of case series and comparisons with open surgery, which generally report similar success rates, smaller scars, less pain and a shorter hospital stay, with longer operating time and higher cost. Long-term studies are fewer than for open surgery, and results depend on the surgeon's experience with the robot.
A realistic expectation is that most patients are cured, a minority need further procedures, and some children have temporary difficulty passing urine after both sides are repaired. A clinic should not promise a certain outcome.
Who is a good candidate for robotic reimplantation?
Good candidates have a clear diagnosis on imaging, a bladder that can be reached through keyhole access and enough ureter length to be re-attached without tension. In adults it is often used for lower ureter strictures and injuries, and in children for reflux that has caused infections or kidney scarring despite treatment. It may be less suitable if there is an active urinary infection, which must be treated first, severe scarring from earlier surgery or radiotherapy, or a ureter that is too short for direct re-attachment. In that case the surgeon may combine it with a bladder flap, known as a psoas hitch or Boari flap, or advise open surgery.
Robotic ureteral reimplantation cost in Turkey compared with the UK, US and Germany
The figures below are approximate ranges for one operation, not hospital quotes. The price depends on whether one or both ureters are repaired, the complexity of the repair, whether a bladder flap is needed, the hospital stay and what the package includes. Each hospital confirms its price in a written quote.
| Country | Approximate cost range |
|---|---|
| Turkey | €6,000 – €14,000 |
| United Kingdom | €9,000 – €20,000 |
| United States | €20,000 – €55,000 |
| Germany | €9,000 – €20,000 |
A package normally includes the imaging review and tests, the robotic operation, anaesthetist, hospital nights, the stent and catheter, a later stent removal if done there, medication and airport transfers. Ask whether the stent removal and follow-up scans are included and where they will be carried out. Our free quote page asks the hospital to list these items in writing.
Robotic, open or endoscopic treatment: how do the options compare?
The choice depends on the diagnosis, the child or adult's anatomy and previous treatment.
| Option | Best suited to | Typical limits |
|---|---|---|
| Robotic reimplantation | Reflux with infections, lower ureter blockage or injury; keyhole access wanted | Higher cost; needs a robot-trained urologist |
| Open reimplantation | Complex anatomy, short ureter, previous surgery | Larger incision, longer stay |
| Endoscopic injection or dilation | Mild reflux or short stricture | Lower success rate in some cases; repeat treatment may be needed |
How is the operation done step by step?
You have a general anaesthetic. Small ports are placed in the lower abdomen and the robot is docked. The surgeon exposes the ureter, frees the diseased end and either buries it in a tunnel within the bladder wall (the tunnel acts like a valve to stop reflux) or, in the extravesical method, lays it against the outside of the bladder muscle. Where the ureter is narrowed, the diseased part is removed and the healthy end is stitched to the bladder over a thin stent. A urinary catheter drains the bladder. Operating time is commonly two to four hours, longer if both sides are repaired or a flap is needed.
What are the stent and catheter for, and how long do they stay?
The ureteral stent is a thin tube from the kidney to the bladder that keeps the new join open while it heals. A catheter keeps the bladder empty so the join is not under pressure. The catheter usually stays one to seven days, and the stent several weeks, then is removed in a short procedure with a camera. Stent symptoms such as urgency, a dull flank ache when passing urine and light blood in the urine are common. Fever, heavy bleeding or being unable to pass urine need urgent attention. Ask the surgeon when the stent will be removed and whether that can be done before you fly home.
Robotic ureteral reimplantation recovery: how long should you stay in Turkey?
Most patients stay in hospital for two to three nights and remain in Turkey for about seven to ten days. You are encouraged to walk the day after surgery.
- Days 1 to 3: soreness around the small incisions, catheter in place, plenty of fluids.
- Week 1: catheter removed, urine may be blood-tinged, light activity only.
- Weeks 2 to 6: stent symptoms, return to desk work after about two weeks for most adults, no heavy lifting.
- Follow-up: ultrasound or scan weeks to months afterwards to confirm the kidney is draining and, in reflux, that it has resolved.
Short flights are usually allowed after the surgeon has checked you. Children's activity restrictions are set by the paediatric urologist.
What are the risks and complications?
Common effects are pain, bruising, stent discomfort and blood in the urine. Less common problems include a urinary infection, a leak of urine at the join, a new narrowing of the ureter, persistent or recurrent reflux, temporary difficulty emptying the bladder, bleeding, injury to nearby organs and conversion to open surgery. The NHS and the European Association of Urology explain that these are uncommon in experienced hands, and follow-up scans exist to find problems early. Ask the surgeon how many robotic reimplantations they perform each year and how they manage a leak.
How to choose a hospital and what to ask
Check that a urologist with reconstructive and robotic experience will operate (a paediatric urologist for a child), that the hospital is licensed with anaesthesia and intensive-care back-up and that your scans are reviewed before a quote is given. Red flags include a quote without imaging, promises of a certain cure, no plan for stent removal and no arrangement for follow-up scans at home. See how our process works for the steps from your scans to surgery.
- Is a robotic approach right for my diagnosis, or would another operation suit me better?
- How long will the stent and catheter stay in, and where will they be removed?
- How many robotic reimplantations has the surgeon performed?
- What scans will I need afterwards, and can they be done at home?
- What happens if the join leaks or narrows?
The same urology departments also treat conditions such as circumcision and penis enlargement, which are separate procedures with their own plans.
Hospitals with Urology in Turkey
Frequently asked questions
It is an operation in which a ureter is detached from the bladder and re-attached in a new position using a robotic system through small incisions. It treats reflux, blockage or injury at the ureter and bladder junction.
It has a high success rate for stopping reflux and relieving blockage in suitable patients. A minority need further treatment, and results depend on the diagnosis and the surgeon's experience.
Approximate costs are €6,000 to €14,000 in Turkey, against about €9,000 to €20,000 in the UK. The price depends on whether one or both sides are repaired and on the hospital stay.
Series generally report similar success rates, with smaller scars and a shorter stay for robotic surgery. Long-term studies are fewer, and open surgery remains the choice for some complex cases.
Most people stay two to three nights in hospital and return to desk work after about two weeks. The stent stays for several weeks and heavy lifting is avoided for about six weeks.
You are asleep during the operation. Afterwards there is soreness at the small incisions and stent discomfort, usually managed with simple medication and easing over a few weeks.
Yes, for reflux that has caused infections or scarring, performed by a paediatric urologist. Some children have temporary trouble emptying the bladder after both sides are repaired.
Usually several weeks. It is removed in a short outpatient procedure with a small camera, and the hospital can tell you if this can be done before you fly.
Mild reflux may be watched with antibiotics, and some narrowings can be treated with a stent, balloon or injection. Open surgery is another option for complex cases.
Plan for about seven to ten days, including two to three hospital nights and a check before you fly. If the stent is removed before travel, allow the longer end.
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