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Segmental ureterectomy and reimplantation: keeping the kidney | CION Cancer Clinics
A segmental ureterectomy removes only the part of the ureter, the tube from kidney to bladder, that holds the tumour. The healthy end is then stitched back into the bladder, which is called reimplantation, so the kidney stays. It is mainly considered for a low tumour that looks low grade, or when losing a kidney is not safe. This page explains who it suits, how it is done and what follows. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What is a segmental ureterectomy with reimplantation?
- Who is this operation usually considered for?
- What happens, from planning to the first check?
- How does it compare with removing the kidney?
- Three things families believe, and what is actually true
- Which words will you see, in plain language?
- Who does this not suit, and what can this page not tell you?
- Common questions about segmental ureterectomy
The short answer
What is a segmental ureterectomy with reimplantation?
A segmental ureterectomy removes only the diseased stretch of the ureter, the tube that carries urine from the kidney down to the bladder. When the tumour sits in the lower part, the surgeon removes that stretch with a small ring of bladder wall, then joins the healthy end of the ureter back into the bladder. That rejoining is the reimplantation, and it means the kidney stays.
Why keep the kidney at all?
The usual operation for a tumour in the ureter is a nephroureterectomy, which takes the kidney, the whole ureter and a cuff of bladder. That is thorough, but it leaves you with one kidney. For some people that matters a great deal. Someone may already have only one working kidney. Someone else may have weak kidneys on both sides, or tumours on both sides.
Why the lower ureter is the usual place
The lower ureter runs close to the bladder. After the tumour is cut out, the remaining tube can usually reach the bladder again. A tumour higher up leaves a longer gap. Joining two cut ends of the ureter to each other is possible, but it is done far less often, because that join is more likely to narrow or leak.
Who it is for
Who is this operation usually considered for?
Your team weighs the tumour and your kidneys together. These are the situations where it usually comes up.
A low tumour that looks low grade
A single tumour in the lower ureter that looks low grade on biopsy. Low grade means the cells look close to normal and tend to grow slowly.
What the team checks
- The grade from the telescope biopsy
- Whether the scan shows growth into the wall
- Whether there is only one tumour
Only one working kidney
If the kidney on the affected side is your only working kidney, removing it would mean dialysis. Keeping it can be worth a higher chance of the tumour returning.
Weak kidneys on both sides
Long-standing diabetes, high blood pressure or older age can leave both kidneys working below normal. Losing one may tip the balance towards kidney failure.
Tumours on both sides
This is rare. When both upper tracts are affected, the aim becomes keeping as much working kidney as can be kept safely.
Not sure whether this applies to you?
Ask an oncologistStep by step
What happens, from planning to the first check?
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Tests before the operation
A CT urogram, a scan with dye that outlines the kidneys, ureters and bladder. A ureteroscopy, where a thin telescope goes up through the bladder to see and sample the tumour. Blood tests, and sometimes a kidney scan, show how much work each kidney does.
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The operation itself
You are fully asleep. The operation is done open or by keyhole, depending on the tumour and the centre. The surgeon removes the diseased stretch with a margin, a rim of healthy tube on each side, and nearby lymph nodes where needed.
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Bridging the gap
If the remaining ureter will not reach the bladder comfortably, the bladder can be lifted towards it and stitched to a muscle. For a longer gap, a flap of bladder wall can be shaped into a tube. The surgeon decides this during the operation.
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The tubes you wake up with
A thin soft tube called a stent runs inside the ureter from kidney to bladder, so the join can heal. You will usually also have a catheter in the bladder and a drain beside the wound.
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Going home, and the stent coming out
The drain and catheter come out over the following days. The stent stays for some weeks and is removed later with a short telescope procedure.
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The first check
A cystoscopy, a look inside the bladder with a thin camera, and a scan of the kidney and ureter. These checks continue for years.
Side by side
How does it compare with removing the kidney?
Segmental ureterectomy
Nephroureterectomy
Keeps the kidney and most of the ureter
Removes the kidney, the whole ureter and a bladder cuff
Suits a low tumour, usually low grade
Suits most tumours, including high-grade ones
The ureter left behind can grow a new tumour
No ureter is left on that side to watch
Telescope checks of the kidney side as well as the bladder
Bladder checks and scans of the other kidney
A new join that can narrow or leak
No join in the ureter to heal
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Commonly believed
Three things families believe, and what is actually true
"Keeping the kidney is always the safer choice."
Keeping the kidney keeps its work, but the ureter left behind can grow a new tumour. A high-grade tumour treated too narrowly is a bigger danger than living with one kidney. Which way is safer depends on the tumour and on your kidneys, and your team weighs both.
"Once that part is cut out, the cancer is finished."
The operation removes what can be seen. Urothelial cancer, the type that starts in the lining of the urinary tract, tends to appear again elsewhere in that lining. That is why regular checks of the bladder and the remaining ureter are part of the plan, not an extra.
"The stent means something went wrong."
The stent is placed on purpose at the end of the operation. It holds the new join open while it heals. An urge to pass urine often, an ache in the side and a little pink urine are common while it is in.
On your report
Which words will you see, in plain language?
- Distal ureter
- The lower part of the ureter, closest to the bladder. Most segmental operations are for tumours here.
- Ureteroneocystostomy
- The medical name for joining the ureter into a new opening in the bladder. It is the reimplantation.
- Psoas hitch
- Stitching the bladder up to a muscle at the back of the pelvis, so it reaches a shorter ureter.
- Boari flap
- A strip of bladder wall rolled into a tube to bridge a longer gap.
- DJ stent
- A soft tube with a curl at each end that sits inside the ureter while the join heals.
Being straight with you
Who does this not suit, and what can this page not tell you?
A segmental ureterectomy is usually not suited to a high-grade tumour when the other kidney works well. It is also not usually suited to a tumour that has grown deep into the wall or beyond it, to several tumours along the ureter, or to a tumour in the kidney's collecting area, the renal pelvis. In those cases most teams discuss removing the kidney and ureter instead. Exceptions are made on kidney function, not on preference.
What your team weighs
The grade and stage of the tumour, where it sits, how well each kidney works, your age and fitness, and whether you can return for checks for years. Useful questions to ask: how sure are we of the grade from a small biopsy? What happens if the final report shows a higher grade? How often will I need a telescope check of the ureter?
What this page cannot tell you
It cannot say whether this operation is right for you. It cannot tell you your own chance of the tumour returning, or how your kidneys will do afterwards. Those answers come from your own reports and a surgeon who has examined you.
Questions we are asked
Common questions about segmental ureterectomy
Will I have to live with a urine bag after this operation?
No. The ureter is joined back into your own bladder, so you pass urine in the normal way. For a short time a catheter drains the bladder into a bag while the joins heal. It comes out before or soon after you go home, depending on how the bladder is healing.
How long will I be in hospital?
That depends on whether the operation is open or keyhole, how the join is made and how quickly you recover. Your surgeon can give you an expected stay for your own plan. Ask for it before the day, so the family can arrange leave and travel from the district.
Does the stent hurt?
Most people are aware of it rather than in pain. Common effects are an urge to pass urine often, a dull ache in the side when passing urine, and pink urine after activity. Tell your team if the pain is severe, the urine turns dark red with clots, or you develop a fever.
What if the final report shows a high-grade tumour?
The biopsy taken before surgery is small and can miss the worst part. If the report on the removed segment shows a higher grade or deeper growth, your team will discuss the next step with you. That can include a further operation to remove the kidney, or treatment such as chemotherapy.
Can the tumour come back on the same side?
It can. The lining of the kidney and the remaining ureter can grow a new tumour, which is the trade-off for keeping the kidney. Regular scans and telescope checks are there to find a new tumour while it is small and can often be treated with a smaller procedure.
Will my kidney work normally afterwards?
Usually the kidney keeps working, because its tube still drains into the bladder. Sometimes the join narrows over time and slows the drainage, which can strain the kidney if it is not found. That is one reason scans are repeated and kidney blood tests are part of follow-up.
Is keyhole or robotic surgery better for this?
Open and keyhole approaches are both used, and the choice depends on the tumour, your body and the surgeon's experience. What matters most is a clear margin and a sound join. Ask your centre which approach they plan, why, and how often they perform this particular operation.
Is it covered by Aarogyasri or insurance?
Surgery for a urinary tract cancer is often covered when it is part of an approved treatment plan. Aarogyasri, CGHS, ECHS and EHS are accepted, and most cashless insurers are empanelled. Call the helpline with your card or policy details and we will help you check your own cover.
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Dr. Vinay Mamidala
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Sources
- National Cancer Institute — Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ) - Patient Version
- Cancer Research UK — Kidney cancer
- American Cancer Society — Bladder cancer
- NHS — Kidney cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Kidney-Sparing Surgery for Upper Tract TumoursAll the ways a kidney can be kept, side by sideUreteroscopy and Laser AblationThe telescope option for small tumours higher upNephroureterectomy: What Is RemovedThe alternative, when the kidney has to goBladder Surveillance After Upper Tract SurgeryThe checks that follow either operationDrains, Tubes, Lines and CathetersLiving with the stent, catheter and drain
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Wondering whether your kidney can be kept?
Send us the biopsy and scan reports, or call the helpline. A surgical oncologist will go through what the reports point towards and what to ask your team. One helpline serves every CION centre.