Psoas-hitch ureteroneocystostomy: experience with 181 cases.

The operative technique, indications and results of the psoas-hitch ureteroneocystostomy in 181 patients are reported. The principles of this procedure are as follows. Dissection of the ureter under direct vision, fixation of the mobilized bladder to the psoas muscle, longitudinal opening of the bladder up to the point of fixation, implantation of the ureter in an immobile bladder portion using a long submucosal tunnel. The original course of the ureter is maintained and is identical to the axis of the fixed bladder part. The broad spectrum of indications includes the repair of distal ureteral defects due to iatrogenic lesion, radiotherapy or inflammation, correction of congenital ureteral anomalies as well as therapy of reflux in adulthood and complicated reflux in children. Especially in cases in which previous ureteroneocystostomy has failed, the psoas-hitch plasty is the method of choice. Contraindications are neurogenic bladder dysfunction and a highly reduced bladder capacity or the impossibility of bladder mobilization because of a 'frozen pelvis'. The success rate of psoas-hitch ureteroneocystostomy performed in 181 cases was 96.7%. The preconditions for a successful ureteroneocystostomy are: tension-free anastomosis between ureter and bladder; antireflux implantation of the ureter through a long submucosal tunnel, and a straight course of the implanted ureter without kinking at the point of entrance into the bladder.