Abstract：Objective: To explore the indications for laparoscopic ureteral reimplantation with psoas hitch, and present our experience and outcomes with the surgery. Methods: We retrospectively reviewed 8 consecutive patients with distal ureteral defects (3-7 cm) who performed laparoscopic ureteral reimplantation with psoas hitch procedure from June 2010 to June 2014. All of the patients underwent laparoscopic ureteral reimplantation with psoas hitch procedure including dissociating ureter and bladder, mobilizing and incising the ureteral defects, revealing psoas or psoas minor tendon, hitching the bladder to the psoas, the outer ureteral membrane anchored to the bladder serosa, and ureteral reimplantation. Results: All procedures were completed without open conversion. The mean laparoscopic time was 88.1 (75 to 120) min, the mean estimated blood loss was 48.6 (10 to 85) mL, the mean length of ureteral defects was 5.2 (3 to 7) cm, the mean pelvic drainage volume was 47.4 (10 to 85) mL, the mean drain duration was 4.5 (3 to 6) days, the mean catheter duration was 6.8 (5 to 8) days, and the mean hospital stay was 8.1 (5 to 10) days. Mean follow-up duration was 16.2 (2 to 51) months, and there was no leakage of urine, no anastomotic stricture and leak, no hydronephrosis, no ureteral dilatation, and no vesicoureteral reflux. Conclusions: Laparoscopic ureteral reimplantation with psoas hitch is a successful method to treat distal ureteral obstruction or stenosis (defects from 3 to 10 cm) with little damage, quick recovery, effective and reliable outcomes. Laparoscopic ureteral reimplantation with psoas hitch is a tension-free, no-twist and nonrefluxing treatment, offering adequate protection of the upper urinary tract, restoring ureteral continuity. It is a useful reconstructive procedure to treat the distal ureteral defects in some cases.
[1]Witzel O. Extraperitoneale ureterocystostomie mit schragkanalbildung. Zentralbl Gynakol, 1896,20:296-303. [2]Ehrlich RM, Gershman A, Fuchs G. Laparoscopic vesicoureteroplasty in children: initial case reports. Urology, 1994,43(2): 255-261. [3]Manassero F, Mogorovich A, Fiorini G, et al. Ureteral reimplantation with psoas bladder hitch in adults: a contemporary series with long-term follow-up. Sci World J, 2012,2012:379316. [4]Li Y, Li C, Xiong Y, et al. Reconstructing full-length ureteral defects using a spiral bladder muscle flap with vascular pedicles. Urology, 2014, 83(5):1199-1204. [5]Kowalczyk JJ, Keating MA, Ehrlich M. Femoral nerve neuropathy after the psoas hitch procedure. Urology, 1996,47(4):563-566. [6]Maldonado PA, Slocum PD, Chin K, et al. Anatomic relationships of psoas muscle: clinical applications to psoas hitch ureteral reimplantation. Am J Obstet Gynecol, 2014,211(5):563.e1-6. [7]Crook TJ, Steinbrecher HA, Tekgul S, et al. Femoral nerve neuropathy following the psoas hitch procedure. J Pediatr Urol, 2007,3(2):145-147. [8]Patil NN, Mottrie A, Sundaram B, et al. Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: A multi-institutional, Multinational Evaluation. Urology, 2008,72(1):47-50. [9]朱捷,高江平,张旭,等.机器人辅助腹腔镜非乳头再植术.临床泌尿外科杂志,2010, 25(6),405-418. [10]张旭.泌尿外科腹腔镜手术学.北京:人民卫生出版社,2008:165. [11]Tahmaz L, Irkilata HC, Goktolga U, et al. Modified psoas hitch with Lich-Gregoir Onlay technique for the reconstruction of lower ureter during gynecologic or obstetric operations. Urol Int, 2010,85(3):257-260.
