Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
In gynecological oncologic surgery, partial ureteral resection may be required to achieve a complete resection of the disease.1 According to the length of ureteral defect, ureteroneocystostomy with psoas hitch can be indicated for ureteral reimplantation, especially when the resection involves the pelvic portion of the ureter. The principle of the psoas hitch technique is to mobilize the bladder, to transpose it to the ipsilateral psoas muscle, and to suture the ureter into the bladder with a tension-free anastomosis. However, when ureteral resection is too large to perform a ureteral reimplantation with psoas hitch technique, Boari bladder flap can be performed.2
The psoas hitch technique was performed on a 75-year-old patient diagnosed with a pelvic recurrence of a uterine sarcoma previously treated by total hysterectomy, bilateral salpingo-oophorectomy and adjuvant radiotherapy. The management of this recurrence required neoadjuvant chemotherapy with doxorubicin and dacarbazine before the surgical procedure. The surgery comprised the en-bloc removal of the recurrence with a rectosigmoid resection and the resection of the pelvic portion of the left ureter. The patient consented to publication of this case study and the accompanying images.
The video shows our proposed standardized surgical procedure which takes an open approach to create psoas hitch ureteral reimplantation in a stepwise approach (Video 1). The surgery also included a mechanical colorectal anastomosis and an omental flap which are not included in this video.
We divided the procedure into 10 steps:
Step 1: Specimen removal
Step 2: Ureteral mobilization
Step 3: Bladder mobilization
Step 4: Bladder fixation to the psoas muscle (psoas hitch)
Step 5: Cystotomy
Step 6: Ureter spatulation
Step 7: Posterior wall ureterovesical anastomosis
Step 8: Pig-tail stent insertion
Step 9: Anterior wall ureterovesical anastomosis
Step 10: Bladder closure
Ureteroneocystostomy with psoas hitch should be considered for ureteral reimplantation after pelvic ureteral resection for gynecological malignancies,3 particularly those located close to the pelvic brim, as it allows a ureterovesical tension-free anastomosis. Post-operative complications can include urinary leakage, hydronephrosis due to ureteral stricture, urinary tract infection and stent-related dysuria.3 4 Previous radiotherapy is associated with a higher incidence of post-operative complications. These can usually be managed with a conservative approach, without surgical reintervention.3 4
Data availability statement
There are no data in this work.
Patient consent for publication
Contributors HL: Conceptualization, video editing, writing-original draft. MAA: Conceptualization, video editing, supervision, writing-review. KV: Conceptualization, video editing, writing-original draft. A-SN: Conceptualization, video editing, writing-original draft. AM: Conceptualization, project administration, supervision, writing-review. GF: Guarantor, conceptualization, project administration, surgery and video recording, supervision, writing-review.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.