Indications for combined psoas-bladder hitch procedure with Boari vesical flap

The combination of two operative methods ordinarily used for correction of injury to the pelvic portion of the ureter, the psoas-bladder hitch procedure and the Boari vesical flap, allows repair of injuries of the middle third of the ureter. The proximal third of the ureter becomes easily accessible for reimplantation in the tunneled Boari flap, provided the mobilized and extraperitonealized bladder is fashioned into a sausage-like extension toward the psoas muscle. Possibilities for a longer Boari flap exist provided the bladder is of normal capacity and one adheres strictly to the recommended technique for fashioning a bladder flap, using a long oblique segment of the anterior bladder wall.