Modified Psoas Hitch with Lich-Gregoir Onlay Technique for the Reconstruction of Lower Ureter during Gynecologic or Obstetric Operations

Abstract

Aims: We retrospectively review patients who underwent ureteral implantation with a psoas hitch during obstetric or gynecologic operations and describe a new modification. Methods: Between December 1997 and May 2005, 20 patients between 26 and 56 years underwent ureteral reimplantation by using the nonrefluxing, extravesical Lich-Gregoir onlay technique with psoas hitch at our institution by the same reconstructive surgery team. Additionally, we used a urethral catheter balloon as a landmark for the bladder mucosa and fixed the bladder to the psoas tendon by using the balloon. We performed 14 ureteral reimplantations during the surgery as intraoperative reconstruction. In 6 patients, delayed reconstruction of the ureter was performed a few days following the previous operation. Results: For intraoperative and delayed reconstructions, the mean operation time for ureteral reimplantation was 24 and 75 min. We took out the urethral catheter on the second operative day and the anastomotic drain on the third. The average hospital stay was 5.7 days. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis or compromised renal function occurred. No patient required reoperation. Conclusions: Modified psoas hitch ureteral reimplantation is an effective and safe way of reconstruction for treating defects in ureteral length.

Laparoscopic Ureteral Reimplantation underneath Broad Ligament Tunnel for Female Vesicoureteral Stenosis: A Technical Innovation

“…Since Nezhat and Nezhat [2] reported the first laparoscopic ureteroureterostomy, laparoscopic ureteral reimplantation has evolved from an experimental technique to an efficacious surgical modality [4]. As experience with the laparoscopic ureteral reconstructive procedure has increased, more procedures have been described in the literature, such as end-to-end-anastomosis, ureteroneocystostomy, vesicopsoas hitch and Boari flap [4,20,21]. …”

Ureteral Reimplantation with Psoas Bladder Hitch in Adults: A Contemporary Series with Long-Term Followup

“…Although the evaluation criteria have changed over time, ureteral reimplantation with bladder psoas hitch has maintained an elevated success rate over time in recent series of adult patients [7, 8]. …”

“…However, following the publication of extensive series from Germany in the 1980s including pediatric and adult cases with a relatively short followup [4, 5], long-term data on the efficacy of this procedure have been relatively scarce in the last two decades [6–8]. …”