Vesico-psoas Hitch Research Articles

Cadaveric surgical demonstration of middle to distal ureteral injury repairs in urologic and gynecologic surgeries.

Iatrogenic ureteral injuries can occur during any surgery but are more likely to occur during urologic and gynecologic procedures. The middle and distal ureter are especially at risk of injury during these surgeries. The objective of this surgical educational video was to demonstrate how to repair middle to distal ureteral injuries with the following techniques: direct ureteroureterostomy, ureteroneocystotomy, vesico-psoas hitch, and Boari-Ockerblad bladder flap. A female cadaver was used to show how to surgically repair injuries to the middle and distal ureter. Middle to distal ureteral injuries occurring during urologic and gynecologic surgeries can be repaired by the techniques demonstrated in this video manuscript.

39: Repair of middle to distal ureteral injuries in urologic and gynecologic surgeries

Iatrogenic ureteral injuries can occur during any surgery but are more likely to occur during urologic and gynecologic procedures. The middle and distal ureter are especially at risk of injury during these surgeries. The objective of this video was to demonstrate how to repair middle to distal ureteral injuries that may occur during urologic and gynecologic surgeries with the following techniques: direct ureteroureterostomy, ureteroneocystostomy, vesico-psoas hitch, and Boari-Ockerblad bladder flap. A female cadaver was used to show how to repair injuries to the middle and distal ureter. Each repair technique was surgically demonstrated. Middle to distal ureteral injuries occurring during urologic and gynecologic surgeries can be repaired by the techniques demonstrated in this video.

Laparoscopic Ureteroneocystostomy with a Vesicopsoas Hitch in 10 Steps

Study ObjectiveLaparoscopic ureteroneocystostomy with a vesicopsoas hitch has the advantages of a minimally invasive approach. The standardization and description of the technique are the main objectives of this video. We described this procedure in 10 steps, which could help to understand and perform this procedure. MethodsThis video presents an approach to laparoscopic ureteroneocystostomy with a vesicopsoas hitch, which was clearly divided into 10 steps. The local institutional review board was consulted and ruled that approval was not required for this video article because the video describes a technique and does not report a clinical case. The patient cannot be identified, and she gave informed consent. ResultsThe 10 steps are as follows: step 1, identification of the healthy ureter; step 2, identification of the stenotic part; step 3, section of the ureter; step 4, bladder mobilization; step 5, anterior cystostomy; step 6, psoas hitch; step 7, closure of the anterior cystostomy; step 8, posterior spatulation of the ureter; step 9, cystostomy of the superolateral bladder dome; and step 10, ureteral suture to the bladder. ConclusionLaparoscopic ureteroneocystostomy with a vesicopsoas hitch is an effective technique for intrinsic ureteral endometriosis; it usually needs ureteral resection with end-to-end reanastomosis or reimplantation if the anastomosis is in tension. The 10 steps help to perform each part of surgery in logical sequence, making the procedure faster to adopt and learn. The standardization of laparoscopic techniques could help to reduce the learning curve.

Management of iatrogenic ureteral injury.

Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. There is also potential for considerable ureteral injury during endoscopic procedures for ureteric pathology such as tumor or lithiasis. While maneuvers such as perioperative stenting have been touted as a means to avoid ureteral injury, these techniques have not been adopted universally, and the available literature does not make a case for their routine use. Distal ureteral injuries are best managed with ureteroneocystostomy with or without a vesico-psoas hitch. Mid-ureteral and proximal ureteral injuries can potentially be managed with ureteroureterostomy. If the distal segment is unsuitable for anastomosis then a number of techniques are available for repair including a Boari tubularized bladder flap, transureteroureterostomy, or renal autotransplantation. In rare cases renal autotransplantation or ureteral substitution with gastrointestinal segments may be warranted to re-establish urinary tract continuity. Laparoscopic and minimally invasive techniques have been employed to remedy iatrogenic ureteral injuries.

Laparoscopic repair of urogenital fistulae: A single centre experience.

CONTEXT:Sparse literature exists on laparoscopic repair of urogenital fistulae (UGF).AIMS:The purpose of the following study is to report our experience of laparoscopic UGF repair with emphasis on important steps for a successful laparoscopic repair.SETTINGS AND DESIGN:Data of patients who underwent laparoscopic repair of UGF from 2003 to 2012 was retrospectively reviewed.MATERIALS AND METHODS:Data was reviewed as to the aetiology, prior failed attempts, size, number and location of fistula, mean operative time, blood loss, post-operative storage/voiding symptoms and episodes of urinary tract infections (UTI).RESULTS:Laparoscopic repair of 22 supratrigonal vesicovaginal fistulae (VVF) (five recurrent) and 31 ureterovaginal fistulae (UVF) was performed. VVF followed transabdominal hysterectomy (14), lower segment caesarean section (LSCS) (7) and oophrectomy (1). UVF followed laparoscopy assisted vaginal hysterectomy (18), transvaginal hysterectomy (2) and transabdominal hysterectomy (10) and LSCS (1). Mean VVF size was 14 mm. Mean operative time and blood loss for VVF and UVF were 140 min, 75 ml and 130 min, 60 ml respectively. In 20 VVF repairs tissue was interposed between non-overlapping suture lines. Vesico-psoas hitch was done in 29 patients of urterovaginal fistulae. All patients were continent following surgery. There were no urinary complaints in VVF patients and no UTI in UVF patients over a median follow-up of 3.2 years and 2.8 years respectively.CONCLUSION:Laparoscopic repair of UGF gives easy, quick access to the pelvic cavity. Interposition of tissue during VVF repair and vesico-psoas hitch during UVF repair form important steps to ensure successful repair.

Simplified laparoscopic technique for the treatment of long distal ureteral stenosis.

Laparoscopic interventions with the application of vesico-psoas hitch and Boari flap methods for the reconstruction of pronounced ureter defects require considerable physical skill and competence. This case series aims to present our experience in the treatment of long, distal ureteral stenoses via simplified laparoscopic ureteroneocystostomy in 3 male patients in whom the stenoses ranged from 5 cm to 6 cm. Prior to each laparoscopic intervention, intravenous urography and pyelography via a nephrostomy tube were performed. The mean operation time was 157 min (120–180 min), and blood loss averaged 33 ml (20–50 ml). No intra-operative or post-operative complications were recorded. The post-operative hospital stay was ≤ 6 days. Follow-up imaging examinations revealed normal kidney-urinary bladder urine flow in all cases. In conclusion, we consider that simplified ureteral replantation facilitates laparoscopic treatment of long, distal ureteral stenoses.

Laparoscopic ureteroneocystostomy and vesicopsoas hitch for infiltrative ureteral endometriosis

The aim of the study was to assess the safety and efficacy of laparoscopic treatment of distal infiltrative ureteral endometriosis with segmental ureteral resection, ureteroneocystostomy, and vesicopsoas hitch. We performed a retrospective analysis of perioperative data and looked at follow-up outcomes of patients with deep endometriosis with ureteral involvement treated by laparoscopic vesicopsoas hitch. Six patients were treated for left ureteral endometriosis in the study period. Four of those were diagnosed during previous laparoscopies. A ureteroneocystostomy (Lich-Gregoir reimplantation procedure) with vesicopsoas hitch was fashioned laparoscopically in all cases, and a double-J stent was applied intraoperatively. There were no intraoperative or postoperative complications and no cases of extravasation of contrast at cystogram one week after surgery. The median follow-up time was 38 months (range 12–56). All patients had normal renal ultrasound or intravenous pyelogram results at one year follow-up. This study confirmed that laparoscopic ureteroneocystostomy and vesicopsoas hitch is a safe and effective option in the management of distal ureteral endometriosis. In view of the small size of this series, multicenter studies are needed to confirm these conclusions.

Laparoscopic extravesical neoureterocystostomy and vesicopsoas hitch for infiltrative ureteric and vesical endometriosis: case report

We present a multidisciplinary approach to the management of a 41-year-old woman who presented with an acute on chronic history of pelvic pain and urinary tract symptoms. The underlying pathology was found to be infiltrative ureteric and vesical endometriosis. The extent of the disease had caused partial ureteric obstruction. The patient subsequently underwent laparoscopic excision of the endometriosis with a laparoscopic extravesical neoureterocystostomy and vesicopsoas hitch, performed by an advanced laparoscopic gynaecologist and a urologist.

Prise en charge des lésions urétérales iatrogènes

Ureteral injury is a rare but potential serious complication that can occur during a variety of general surgical procedures. Knowledge of the course of the ureter is the first step toward preventing ureteral injuries. While some injuries are noticed intraoperatively, most are missed and present later with pain, sepsis, urinary drainage or renal loss. The choice of treatment is based on the location, type and extend of ureteral injury. For injuries recognized during open surgery, when involving the distal 5 cm of the ureter, an antireflux ureterocystostomy such as the Politano-Leadbetter procedure or a vesicopsoas hitch can be performed. For the middle ureter, an ureteroureterostomy is satisfactory and for the proximal ureter, most injuries can be managed by transureteroureterostomy. In complex situations intestinal interposition, autotransplantation or even nephrectomy can be considered. The majority of patients with delayed diagnosed ureteral injuries should be managed by an initial endo-urologic approach.

Laparoscopic vesicopsoas hitch for infiltrative ureteral endometriosis

Objective: To report the technique and outcome of a laparoscopic vesicopsoas hitch used for the treatment of infiltrative ureteral endometriosis. Design: Case report. Setting: A tertiary care center. Patient(s): A 36-year-old woman with infiltrative endometriosis of the ureter. Intervention(s): A laparoscopic vesicopsoas hitch. Main Outcome Measure(s): The return of normal ureteral function as measured by IV pyelography and ultrasonography. Result(s): After partial ureteral resection, it was noted that a tension-free anastomosis to the bladder was not possible. Thus, a laparoscopic vesicopsoas hitch was performed. Conclusion(s): A vesicopsoas hitch can be performed successfully by laparoscopy.

Ureteral reimplantation using the psoas bladder-hitch. Experience based on 111 operations in 100 patients

In a 12-year period we performed 111 ureteral reimplantations with vesico-psoas hitch in 100 patients. The indication was a stricture of the lower third of the ureter in 51 ureters, vesicoureteral reflux in 31 ureters, and intraoperative laceration of the ureter in 25 patients. A congenital megaureter was the indication for ureteral reimplantation with psoas hitch in 4 cases. The operative result was classified excellent or good in 72% of the cases, and only 16% had to be regarded as operative failures. Ureteral reimplantation with vesico-psoas hitch is a versatile procedure that suits a number of indications, it is invaluable for the replacement of the lower third of the ureter in difficult cases, and it leads to a good long-term result in a high percentage of patients.

The vesico-psoas hitch as an adjunct to megaureter repair in childhood.

The vesico-psoas hitch usually has been advocated for the management of lower ureteral injuries or failed ureteroneocystostomies when there is inadequate ureteral length. Since 1966 we have used this technique in 36 children with obstructed megaureters. There has been no postoperative obstruction and reflux has been prevented in all but 1 case. The vesico-psoas hitch has proved to be an important adjunct in the repair of the obstructed megaureter, since it allows the construction of a long intravesical ureter, thus avoiding reflux, and locates the new ureteral hiatus in the bladder at a fixed point so that ureteral kinking and obstruction are prevented.

The Use of Vesico-psoas Hitch in Urologic Surgery

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.