This technique was introduced in the middle of the last century and was applied for the treatment of distal ureteric obstruction, ureteric fistulas and ‘distended duplication’ of the upper urinary tract.
The indication to perform psoas hitch include:
1.Injury/obstruction to the ureter above the bifurcation of the internal and external iliac artery. Ureteroureterostomy should not be performed in the distal ureter.
2. Adult non-refluxing ureteral reconstruction – when the patient has recurrent pyelonephritis.
3. Boari flap
4. Non-Mobile ureter – this scenario can occur even when the ureter injury is low but the ureter is completely immobile, and it springs back when we try to anastomose it to the bladder.
5. When it is needed to get out of a radiated field - for example after treatment of cervical cancer, or other cancers.
The basics of psoas hitch include identification of the ureter first and the most distal extent of the healthy ureter. Next, bladder mobilization should be performed, in the anterior, lateral, posterior, and distal aspects. Lastly, it is important to make sure there is no tension when hitching the bladder to the psoas. If tension does exist, the psoas hitch will most likely fail, and another solution will need to be found.
The procedure of psoas hitch should include three solid sutures through the psoas. The stitches should get serosa and muscle, and be composed of long-acting absorbable suture, with a UR 6 needle. Importantly, it is important to make sure not to damage the genitofemoral nerve. It is best to aim for the suture to go through the tendon of the psoas muscle.
Dr. Buckley concluded her talk, stating that psoas hitch is a highly reliable and well-tolerated operation, with extremely high success rates. It can be performed robotically in a safe, simple and reproducible manner. It is important to make sure that all stitches are without any tension so that the procedure is successful.
Presented by: Jill C. Buckley, MD, Urologist, Associate Professor of Urology, UC San Diego Health
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at 2019 3rd Annual North American Robotic Urology Symposium (NARUS), February 8-9, 2018 - Las Vegas, Nevada, United States