Psoas hitch ureteral implantation : relevance and safety

초록

OBJECTIVES: To evaluate the surgical relevance of psoas-hitch ureteral reimplantation. MATERIALS AND METHODS: Between May 1996 and December 2003, 14 patients (8 females and 6 males) underwent psoas-hitch ureteral reimplantation at Inha university hospital. All involved ureters were distal portion of the ureter. Average length of ureteral defect was 1.8cm (range 0.8-4cm). The indications were ureteral injuries associated with gynecological surgeries in 4 cases, stricture due to variable causes in 4 cases, resection of distal ureter tumor in 2 case, megaureter with ureteral obstruction in 1 case, vesicoureteral reflux in 3 case. Treatment included adequate mobilization of the bladder, fixation of the posterolateral corner of the bladder to psoas and ureteral reimplantation with anti-reflux anastomoses. RESULTS: No intraoperative complications occurred. One case of postoperative acute pyelonephritis occurred. At follow-up of 6 months to 5 years (mean 1.8 years) we noticed no hydronephrosis in 11 cases (78.6%), mild hydronephrosis in 3 cases (21.4%). No long-term complications such as chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis, and compromised renal function occured. CONCLUSIONS: Psoas-hitch ureteral reimplantation is a safe, effective procedure for bridging the long defects of the lower ureter without long term sequelae, even for repair of vesicoureteral reflux.