Article Text

Download PDFPDF

Psoas hitch ureteral reimplantation in 10 steps in oncologic surgery
  1. Hélène Leray,
  2. Martina Aida Angeles,
  3. Kelig Vergriete,
  4. Anne-Sophie Navarro,
  5. Alejandra Martinez and
  6. Gwenael Ferron
  1. Department of Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse, France
  1. Correspondence to Dr Gwenael Ferron, Institut Universitaire du Cancer Toulouse Oncopole Departement de chirurgie, Toulouse 31059, France; ferron.gwenael{at}

Statistics from

Request Permissions

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.

Video 1 Ureteroneocystostomy with psoas hitch to perform a ureterovesical tension-free anastomosis after pelvic ureteral resection.

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.

Ethics statements

Patient consent for publication

Ethics approval

Not applicable.



  • Twitter @Alejandra

  • 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.