The Use of Vesico-psoas Hitch in Urologic Surgery

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Abstract
The vesico-psoas hitch is an operation that is ideally suited to the management of lower ureteral injuries, failed secondary or tertiary ureteroneocystostomies and complex problems in which the blood supply to the lower ureter is tenuous. It was performed on 52 patients, 25 in conjunction with ureteroneocystostomy, 8 with damaged ureters and 19 in conjunction with an ileal ureter. None of the patients had ureterovesical stenosis, and functional bladder capacity and emptying were preserved despite extensive mobilization. Reflux was prevented in all but 2 cases. The success of the operation related to the ability to fix the posterior aspect of the bladder to the psoas muscle above the ileac vessels. This procedure provided greater length to perform a more adequate submucosal tunnel to prevent reflux. It was a most helpful maneuver in conjunction with ileal ureters in that a shorter intestinal segment was used, thus decreasing absorptive mucosal surface. The procedure was used successfully in lieu of the more difficult and potentially dangerous procedures, such as transureteroureterostomy. Because the psoas hitch can successfully bypass more than half of the entire ureteral length, in combination with a Boari flap (used in 2 cases), even more extensive ureteral problems may be managed.