Psoas-hitch ureteroneocystostomy: experience with 181 cases

Area of Science:

• Urology
• Surgical Techniques

Background:

• Ureteral reconstruction and management of vesicoureteral reflux present complex clinical challenges.
• Existing ureteroneocystostomy techniques may have limitations, particularly in cases of complex defects or prior surgical failures.

Purpose of the Study:

• To report the operative technique, indications, and outcomes of the psoas-hitch ureteroneocystostomy.
• To evaluate the efficacy of this procedure in a large patient cohort.

Main Methods:

• The psoas-hitch ureteroneocystostomy involves ureteral dissection, bladder fixation to the psoas muscle, and implantation into a long submucosal tunnel.
• Key principles include maintaining the ureter's original course and ensuring a tension-free, straight anastomosis.

Main Results:

• The study analyzed 181 patients who underwent the psoas-hitch ureteroneocystostomy.
• A high success rate of 96.7% was achieved, demonstrating the procedure's effectiveness.

Conclusions:

• The psoas-hitch ureteroneocystostomy is a highly effective treatment for distal ureteral defects, congenital anomalies, and adult/pediatric reflux, especially after failed previous attempts.
• Key to success are tension-free anastomosis, long submucosal tunnels, and a straight ureteral course, avoiding contraindications like neurogenic bladder.