VERSATILITY OF THE ADULT PSOAS HITCH URETERAL REIMPLANTATION

Purpose: The psoas hitch ureteral reimplant has been described in the literature as an excellent method to restore ureterovesical continuity in patients with ureteral defects of various etiologies. However, lon g-term data on the durability of this procedure are lacking. We retros pectively reviewed patients who underwent ureteral reconstruction usin g the psoas hitch reimplantation to determine long-term efficacy. Mate rials and Methods: Ureteral reimplantation in the adult is frequently performed in the setting of ureteral tissue loss secondary to resectio n or injury. The psoas hitch reimplantation is a simple, versatile tec hnique that avoids the inclusion of intestinal segments and can be use d in most patients requiring reimplantation. Indications for surgery a nd the long-term followup were examined in 20 patients undergoing reim plantation using the psoas hitch. Results: The indications for uretera l reconstruction included surgical injury in 13 cases, recurrent pyelo nephritis with reflux in 1, obstruction secondary to cancer in 2, trau ma in 1, retroperitoneal fibrosis in 1 and ureteral stricture in 2. At followup of 1 to 14 years (mean 6) 17 patients have not required furt her intervention for urological problems and have retained normal rena l function. In the 2 patients with cancer ileal conduit was performed later and in 1 flank pain persisted despite negative urological evalua tion. Conclusions: Psoas hitch ureteral reimplantation can be used suc cessfully for bridging various ureteral defects in difficult clinical situations. Adequate renal and bladder mobilization will allow reconst ruction despite long ureteral defects.