CPT® Code 50785

An open ureteroneocystostomy is a surgical procedure that involves the reattachment of the ureter to the bladder. This procedure is specifically indicated when there is a need to create a new connection between the ureter and the bladder, often due to conditions that affect the normal function of the urinary tract. The distal ureter, which is the part of the ureter closest to the bladder, is carefully divided at or near the ureterovesical junction (UVJ), the point where the ureter meets the bladder. Following this, an incision is made in the dome of the bladder wall, extending down to the level of the mucosa, which is the innermost layer of the bladder. A smaller incision is then created in the bladder mucosa itself to facilitate the connection with the ureter. The detached segment of the ureter is then trimmed and its end is spatulated, which means it is shaped to create a larger surface area for the anastomosis, or surgical connection, to the bladder mucosa. This connection is crucial for ensuring that urine can flow from the ureter into the bladder without obstruction. After the ureter is attached, the bladder wall is closed over a 2-3 cm segment of the ureter, forming a tunnel that helps prevent the backflow of urine, known as reflux. The opening at the UVJ is subsequently closed to complete the procedure. In some cases, a temporary ureteral stent may be placed to maintain the patency of the ureter and facilitate healing during the recovery process. This procedure can be performed in various scenarios, including when a vesico-psoas hitch or bladder flap is utilized to accommodate anatomical variations or to enhance the surgical outcome.