title: Anatomic relationships of psoas muscle: clinical applications to psoas hitch ureteral reimplantation.
abstract: OBJECTIVE
  The objective of the study was to examine the anatomic relationship of the genitofemoral and femoral nerves to the psoas major muscle.
  
  
  METHODS
  Dissections were performed in 17 unembalmed female cadavers. Point A was used as the approximate location for placement of psoas hitch sutures and as the reference point from which all measurements were taken. Measurements included the width of the psoas major muscle, psoas minor tendon, genitofemoral nerve branches, and femoral nerve. The relative location of the genitofemoral and femoral nerves to point A and the presence or absence of a psoas minor tendon were documented.
  
  
  RESULTS
  The psoas minor tendon was absent on at least 1 side in 11 specimens (64.7%). The median width of the psoas minor tendon was 7 mm (range, 3-11.5 mm). The median width and depth of the psoas major muscle was 21.5 mm (range, 10-35 mm) and 20.0 mm (range, 11.5-32 mm), respectively. The median width of the genitofemoral nerve was 2 mm (range, 1-4.5 mm) and that of the femoral nerve was 6.3 mm (range, 5-10.5 mm). Overall, 54 genitofemoral nerve branches were identified in 17 cadavers, 30 medial (55.5%), 22 lateral (40.7%), and 2 directly overlying point A (3.7%).
  
  
  CONCLUSIONS
  The exact location for the placement of the psoas hitch sutures will vary, depending on the location of the ureteral injury and the anatomy of the psoas muscle and surrounding structures. A thorough understanding of this regional anatomy should optimize the placement of psoas hitch sutures during ureteral reimplantation procedures and help avoid nerve and vessel injury.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: pedro.maldonado@utsouthwestern.edu.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Maldonado
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Slocum
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Chin
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Marlene M
authors.initials: MM
authors.lastname: Corton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004210:Dissection; D005260:Female; D005267:Femoral Nerve / Q000033:anatomy & histology*; D006801:Humans; D008160:Lumbosacral Plexus / Q000033:anatomy & histology; D008875:Middle Aged; D016658:Psoas Muscles / Q000033:anatomy & histology*; D012092:Replantation / Q000379:methods*; D013536:Suture Techniques; D014513:Ureter / Q000601:surgery*
keywords: femoral nerve; genitofemoral nerve; nerve injury; psoas hitch; ureteral reimplantation