The Use of Vesico-psoas Hitch in Urologic Surgery

No AccessJournal of Urology1 Mar 1978The Use of Vesico-psoas Hitch in Urologic Surgery Richard M. Ehrlich, Arnold Melman, and Donald G. Skinner Richard M. EhrlichRichard M. Ehrlich More articles by this author , Arnold MelmanArnold Melman More articles by this author , and Donald G. SkinnerDonald G. Skinner More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)57478-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. Since 1971 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. © 1978 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByChang S and Koch M (2018) The Use of an Extended Spiral Bladder Flap for Treatment of Upper Ureteral LossJournal of Urology, VOL. 156, NO. 6, (1981-1983), Online publication date: 1-Dec-1996.Gerber G and Schoenberg H (2018) Female Urinary Tract FistulasJournal of Urology, VOL. 149, NO. 2, (229-236), Online publication date: 1-Feb-1993.Mikkelsen D and Lepor H (2018) Innovative Surgical Management of Idiopathic Retroperitoneal FibrosisJournal of Urology, VOL. 141, NO. 5, (1192-1196), Online publication date: 1-May-1989.Ehrlich R, Whitmore K and Fine R (2018) Calycovesicostomy for Total Ureteral Obstruction after Renal TransplantationJournal of Urology, VOL. 129, NO. 4, (818-819), Online publication date: 1-Apr-1983.Gearhart J and Woolfenden K (2018) The Vesico-Psoas Hitch as an Adjunct to Megaureter Repair in ChildhoodJournal of Urology, VOL. 127, NO. 3, (505-507), Online publication date: 1-Mar-1982.Peterson N and Pitts J (2018) Penetrating Injuries of the UreterJournal of Urology, VOL. 126, NO. 5, (587-590), Online publication date: 1-Nov-1981.Stutzman R (2018) Editorial CommentJournal of Urology, VOL. 126, NO. 5, (590-590), Online publication date: 1-Nov-1981.Middleton R (2018) Routine Use of the Psoas Hitch in Ureteral ReimplantationJournal of Urology, VOL. 123, NO. 3, (352-354), Online publication date: 1-Mar-1980.J.W.D. (2018) Editorial CommentJournal of Urology, VOL. 123, NO. 3, (354-354), Online publication date: 1-Mar-1980. Volume 119Issue 3March 1978Page: 322-325 Advertisement Copyright & Permissions© 1978 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Richard M. Ehrlich More articles by this author Arnold Melman More articles by this author Donald G. Skinner More articles by this author Expand All Advertisement PDF DownloadLoading ...