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[The psoas bladder. Experience with 88 operations (author's transl)]
Insights
The psoas bladder procedure offers good results for ureteral reconstruction in children and adults, particularly for tuberculosis cases. It is a valuable alternative when other methods fail to prevent reflux or address ureteral loss.
Area of Science:
- Urology
- Pediatric Urology
- Surgical Reconstruction
Context:
- Psoas bladder (or psoas hitch) is a surgical technique for ureteral reconstruction.
- It is employed in cases of ureteral loss or complex bladder issues.
- Previous reconstructive attempts, megalo-ureters, and pelvic fibrosis are common indications.
Purpose:
- To evaluate the efficacy and outcomes of the psoas bladder technique in 88 pediatric and adult patients.
- To identify key indications, complications, and factors influencing success rates.
- To compare psoas bladder with other reconstructive methods like the Leadbetter-Politano operation.
Summary:
- The study reviewed 88 psoas bladder procedures, noting good outcomes in primary pediatric cases and adults with tuberculosis.
- Complications included ureteral stenosis (4 in adults, 1 in children) and vesicoureteral reflux (6 in children) primarily due to short submucosal tunnels.
- The technique is recommended for ureteral loss and when simple ureteral advancement fails to prevent reflux, serving as an alternative to Leadbetter-Politano.
Impact:
- Highlights the psoas bladder as a crucial reconstructive option for complex ureteral defects.
- Emphasizes the importance of adequate dissection and tension-free anastomosis for successful outcomes.
- Provides evidence supporting its use as a viable alternative in specific urological reconstructive scenarios.
Abstract:
The authors report their experience with 88 cases of psoas bladder in children and in adults. The essential indications have been failure of previous ureterovesical implantation, certain megalo-ureters, tuberculous stenosis, and pelvic fibrosis in adults. In 32 operations on children there was only a single case of stenosis, but six cases of residual reflux all linked to a too short submucous passage. In the 56 operations in adults there were four ureteral stenoses. Note the almost constant good results in children operated for the first time, and in adults operated for tuberculosis. The authors stress several points: - the psoas bladder is the first type or reparative surgery to consider when one is confronted with loss of substance of the ilio-pelvic ureter; - in reparative surgery of the terminal ureter, the psoas bladder is indicated each time it is not possible to prevent reflux by simple advancement of the ureter submucously. The psoas bladder seems to the authors to be an advantageous alternative to the Leadbetter-Politano operation; - the need to amply dissect the dome of the bladder and, if necessary, the lateral aspects of the bladder, the ureter, even the kidney and the renal pedicle in difficult repairs when there is extensive loss of tissue; - the obligation to renounce this technique whenever the dissection pushed to the limit does not allow an anastomosis without tension.