LUMBOSACRAL PLEXUS INJURY BY PSOAS HITCH OPERATION

The psoas hitch operation is used for the management of ureteral disea se requiring replacement of varying lengths of the ureter. During this procedure the bladder is fixed to the psoas by 2 or 3 hitches of nonr esorbable suture. Astonishingly, peripheral nerve injury to the lumbos acral plexus has not yet been described as a complication even though it has been seen when the psoas muscle was hitched unintentionally dur ing abdominal surgery. Within 14 days we saw 2 patients with damage to parts of the lumbosacral plexus following a psoas hitch. In one case, hypesthesia and exercise-related pain in the areas supplied by the ge nitofemoral, the ilioinguinal and femoral nerve persisted, suggesting inclusion of at least parts of those nerves in the hitch. Initial pare sis of hip flexion did not persist and the second patient recovered wi thout sequelae. According to the literature this kind of complication does not occur if visible nerves are avoided and stitches an used that are no deeper than 3 mm into the psoas muscle.