The use of vesico-psoas hitch in urologic surgery

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 has been 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 has had ureterovesical stenosis, and functional bladder capacity and emptying have been preserved despite extensive mobilization. Reflux has been 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 provides greater length to perform a more adequate submucosal tunnel to prevent reflux. It has been a most helpful maneuver in conjunction with ileal ureters in that a shorter intestinal segment can be used, thus decreasing absorptive mucosal surface. The procedure has been 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 can be managed. We believe that the vesico-psoas hitch has not received the attention it deserves and that it provides an excellent alternative to more complicated and potentially dangerous procedures.