Modified psoas hitch with Lich-Gregoir onlay technique for the reconstruction of lower ureter during gynecologic or obstetric operations.
OBJECTIVE
We retrospectively review patients who underwent ureteral implantation with a psoas hitch during obstetric or gynecologic operations and describe a new modification.


METHODS
Between December 1997 and May 2005, 20 patients between 26 and 56 years underwent ureteral reimplantation by using the nonrefluxing, extravesical Lich-Gregoir onlay technique with psoas hitch at our institution by the same reconstructive surgery team. Additionally, we used a urethral catheter balloon as a landmark for the bladder mucosa and fixed the bladder to the psoas tendon by using the balloon. We performed 14 ureteral reimplantations during the surgery as intraoperative reconstruction. In 6 patients, delayed reconstruction of the ureter was performed a few days following the previous operation.


RESULTS
For intraoperative and delayed reconstructions, the mean operation time for ureteral reimplantation was 24 and 75 min. We took out the urethral catheter on the second operative day and the anastomotic drain on the third. The average hospital stay was 5.7 days. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis or compromised renal function occurred. No patient required reoperation.


CONCLUSIONS
Modified psoas hitch ureteral reimplantation is an effective and safe way of reconstruction for treating defects in ureteral length.
Tahmaz
Lutfu
L
Department of Urology, Gülhane Military Medical Academy, School of Medicine, Ankara, Turkey.
Irkilata
Hasan Cem
HC
Goktolga
Umit
U
Yildirim
Ibrahim
I
Bozkurt
Yasar
Y
Basal
Seref
S
Dayanc
Murat
M
D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D013513:Obstetric Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D016658:Psoas Muscles / Q000473:pathology; D019651:Plastic Surgery Procedures / Q000379:methods; D012092:Replantation / Q000379:methods; D012189:Retrospective Studies; D013710:Tendons / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*