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

Abstract

We retrospectively evaluated our experience with ureteral reimplantation and psoas bladder hitch to restore urinary tract continuity in patients with lower ureteral defects, since long-term data on the outcomes of this procedure have been relatively scarce in the last two decades. The procedure was performed in 24 patients (7 male, 17 female) with a mean age of 54.6 years. The mean ureteral defect length was 4.8 cm (range 3–10), the ureterovesical anastomosis was performed with simplified split-cuff technique in 18 patients, submucosal tunnel in 2, and direct anastomosis without antireflux technique in 2. Mean followup was 53 months (range 12–125), and there were no reinterventions. Postoperative renal imaging was normal in 22 cases (91.6%) and revealed decreased kidney size in 2, 3 patients presented intermittent flank pain, and 5 had sporadic episodes of lower tract UTI but no one pyelonephritis. Psoas hitch ureteral reimplantation can be successfully used for bridging defects of the lower ureter up to 10 cm in length in difficult clinical situations. It is relatively simple to perform, compared to other procedures of ureteral reconstruction, and it provides adequate protection of the upper urinary tract.

Laparoscopic Extravesical Submucosal Tunneling Ureteroneocystostomy Combined with Psoas Hitch for Medium-Length Distal Ureteral Defects in Adults

“…Open surgical procedures offered good long-term results [3,12] . However, compared with open surgery, laparoscopic surgery causes less pain, early ambulation, and rapid convalescence, although it requires longer operating time and is technically demanding [1,4,10] .…”

“…Traditionally, open ureteral reparation and reimplantation constitute the gold standard therapy in ureteral reconstruction [3] . In the past decade, however, laparoscopic and robot-assisted laparoscopic procedures have become popular in urology and resulted in improved outcomes compared with open surgery, even in lower urinary tract reconstruction procedures that are likely hindered by the narrow pelvic space [1,[4][5][6][7] .…”

Functional Outcomes of Bladder Reconstruction Secondary to Trauma and Ureteral Injury

“…Complications include de-novo irritative voiding complaints, urinoma, bowel obstruction, flank pain, recurrent stricture, pseudodiverticulum, and need for nephrectomy [47,[51][52][53]. A recent study by Mauck et al assessing patients who underwent Boari flap had an overall short-term complication rate of 38 % and long-term rate of 14 %.…”

“…The use of bladder for ureteral reconstruction has demonstrated high success rates of 97-100 % for psoas hitch and 71-91 % for Boari flap [44][45][46][47][48][49][50][51]. Complications include de-novo irritative voiding complaints, urinoma, bowel obstruction, flank pain, recurrent stricture, pseudodiverticulum, and need for nephrectomy [47,[51][52][53].…”

Surgical treatment of the stricture of the lower third of ureter after radiation therapy of pelvic organs

“…Данная методика противо-показана пациентам с микроцистисом. К возможным осложнениям относятся рецидивные стриктуры моче-точников, а также «псоас-синдром», возникающий при интраоперационном повреждении бедренно-по-лового нерва [14].…”