Robotic Ureteral Reimplant Psoas Hitch

Rate :
Loading player ... The player requires Flash Player plugin


Psoas hitch

In the middle of the last century, Dolff [1], Paquin [2]
and Zimmermann et al. [3] developed principles for
ureteroneocystostomy after gynaecological ureter injuries.
Turner-Warwick andWorth [4] adopted these techniques,
named it the ‘Psoas Bladder-Hitch Procedure’ and applied
this technique of ureteroneocystostomy for the treatment
of distal ureteric obstruction, ureteric fistulas and ‘distended
duplication’ of the upper urinary tract.
This technique includes three major advantages for a
complex ureteroneocystostomy: i) Mobilisation of the
bladder with fixation above the iliac vessels to guarantee a
tension-free ureteric anastomosis; ii) Formation of an
adequate submucosal tunnel to prevent VUR; iii)
Implantation of the ureter into an immobilised part of the
bladder to prevent kinking during filling and emptying of
the bladder [5, 6].
In contrast to intravesical techniques for ureteric
reimplantation, the psoas hitch procedure is also well
suited for children with megaureters, as it can be
combined with mobilisation of the ureter up to the kidney,
so that secondary kinking of the ureter can be resolved.
Tapering of a megaureter is rarely required, given that the
diameters of the middle and proximal thirds of the ureter
are usually smaller than that of the distal part, permitting
creation of a submucosal tunnel for anti-refluxing ureteric
The psoas (bladder) hitch technique is an almost universal
approach for ureteric reimplantation whatever the problem
of the distal ureter. If this technique is not possible, an
additional Boari flap may be useful
At the end of the nineteenth century, Boari described a
bladder flap substitution of the distal ureter [7]. The
surgical technique was developed to bridge lesions of the
distal ureter arising from surgical interventions (mainly
gynaecological complications) or tuberculosis [8–11]. A
modification by Übelhör is a deviation from the formal flap

Planning and Preparation

High-grade reflux with dilated ureter not suitable for an
extravesical reimplantation.
• Obstructive and/or refluxive megaureter.
• Double system not suitable for extravesical
• Distal ureteric defects up to 5–8 cm above the ureteric
orifice (for higher defects an additional Boari-flap may be
• Ureteric trauma, ureteric fistula, obstruction of the distal
ureter or distal(solitary, low grade) urothelial cancer of
the ureter.

Specific Instruments and Materials

Optical loupes (2.5–3.5, 50-cm focal length).
• Small Langenbeck retractors.
• 6/0 or 7/0 glyconate monofilament absorbable sutures for
ureteric reimplantation (Monosyn® or Monocryl®).
• 4/0 and 5/0 poly-p-dioxanone monofilament absorbable
sutures (e.g.Monoplus® or PDS®) for bladder closure.
4/0 or 5/0 glyconate or polyglytone monofilament rapidly
absorbable sutures for fixation of stents, cystostomy (e.g.
Monosyn Quick® or Caprosyn®).
• 3/0 poly-p-dioxanone monofilament absorbable sutures
(e.g.Monoplus® or PDS®) for bladder fixation at the
psoas muscle.
• 4, 6 or 8 F polyurethane/polypropylene ureteric stents.
• 10 F pigtail cystostomy catheter.
Patient Preparation
Confirmation of adequate bladder capacity should be
obtained preoperatively to allow a tension-free
In patients with severe ureteric pathology, which might
extend towards the middle or upper third of the ureter,
bowel preparation is advisable in the event of intestinal
ureter substitution becoming necessary.
Acute UTI must be treated preoperatively.
Patient Positioning
The patient is placed supine on the table with ª15 °
overextension. A Foley transurethral catheter is inserted,
which must provide intraoperative access for filling the
bladder during the operation

Figure 1
A supra-inguinal ‘hockey stick’ incision is made
where the length of the cranial extension
(hockey stick handle) depends on the patient's
size and the expected length of the ureteric
defect. In cases with an unexpected length of
pathology, a primary smaller incision may be
extended cranially as needed.

Figure 2
The ureter is exposed through an extraperitoneal
approach. After division of the inferior epigastric
vessels and, in female patients, division of the
round ligament of the uterus (in males
mobilisation the spermatic cord and the
spermatic vessels), the medial umbilical
ligament (umbilical artery) is identified. If there is
severe scarring after previous surgery or
radiotherapy, the ureter is most readily identified
behind the branching of the umbilical artery
from the hypogastric artery (internal iliac artery)
or alternatively at its crossing with the common
iliac artery. The ureter is lifted up by a vessel loop
to ease further preparation. Care must be taken
to preserve the periureteric adventitial tissue with
its inherent blood supply of the ureter.

Figure 3
The ureter is mobilised towards to the bladder as
far as possible, transected and its distal stump
ligated. In cases with a ureteric fistula or an
iatrogenic obstruction, the ureter is transected
above that level. A stay suture is placed into the
proximal ureteric stump at the 6 o'clock position.
The ureter is carefully mobilised cranially to avoid
any injury to the longitudinal ureteric vessels. In
patients (mostly children) with an obstructive
megaureter, the middle and/or proximal third of
the ureter are usually smaller in diameter than
the distal third and can be re-implanted without
tailoring in most cases.

Figure 4
Before commencing its mobilisation, the bladder
is filled with 50 mL (infants) to 200–300 mL
(adults) of saline through the Foley catheter to
ease dissection. The peritoneum is dissected
from the surface of the bladder. In patients with
a long ureteric defect extending higher up,
bladder mobilisation is extended and both the
median umbilical ligament (urachus) and the
ipsilateral medial umbilical ligaments (and
occasionally also the contralateral medial
umbilical ligament) have to be divided. The aim
is to allow a tension-free fixation of the bladder
at the psoas muscle at least 2–3 cm above the
common iliac vessel.

Psoas hitch and Boari flap
Raimund Stein, Peter Rubenwolf, Christopher Ziesel, Mohamed M. Kamal* and
Joachim W. Thüroff*
Division of Paediatric Urology and *Department of Urology, University Medical Center, Johannes Gutenberg
University, Mainz, Germany

Comments : 90

  • Cathey

    Professor   |     |  
      |   12/3/2020 1:41:14 PM
    Writing a phd thesis writing a thesis outline
  • Yoder

    Professor   |     |  
      |   9/25/2021 9:53:28 AM
    Having read this I believed it was very
    informative. I appreciate you finding the time and
    energy to put this short article together. I once again find myself spending way too much time both reading and leaving comments.

    But so what, it was still worthwhile!
  • Darby

    Professor   |     |  
      |   11/5/2020 2:19:33 PM
    Worse preoperative feeding abilities were associated with the presence
    of a tracheotomy, age 2 years, and multiple underlying diagnoses, particularly neurologic ones.

    viagra vs generic generic viagra online
  • Hollingsworth

    Professor   |     |  
      |   8/26/2021 5:13:06 AM
    My brother suggested I would possibly like this web site.
    He was once totally right. This put up truly made my day.
    You cann't imagine simply how a lot time I had spent for this info!
  • Auld

    Professor   |     |  
      |   4/29/2021 7:05:25 PM
    purchasing antibiotics usa
  • Lair

    Professor   |     |  
      |   11/20/2020 8:13:24 PM
    Where to buy generic viagra cheap viagra
  • Fitzmaurice

    Professor   |     |  
      |   12/3/2020 10:55:23 AM
    Custom research paper writing online research paper writer
  • Vanzetti

    Professor   |     |  
      |   3/28/2021 4:38:28 AM
    Customized essay write my essay reviews professional custom essays
  • Boynton

    Professor   |     |  
      |   6/13/2021 12:17:56 PM
    I'm gone to convey my little brother, that he should also go to see this blog on regular basis to get updated from newest news.
  • Driver

    Professor   |     |  
      |   6/9/2021 7:46:02 PM
    I read this post completely on the topic of the comparison of most up-to-date and previous technologies, it's
    awesome article.
  • Hills

    Professor   |     |  
      |   12/2/2020 8:12:51 PM
    Professional essay editing service mba application essay writing service
  • Gartrell

    Professor   |     |  
      |   6/14/2021 3:25:47 AM
    Thank you for the auspicious writeup. It in fact was a amusement
    account it. Look advanced to far added agreeable from you!
    However, how can we communicate?
  • Gilpin

    Professor   |     |  
      |   11/20/2020 9:42:35 PM
    Viagra price in india online 10 sildenafil
  • Lim

    Professor   |     |  
      |   12/3/2020 11:11:37 AM
    Write my paper for me fast write my custom paper
  • Mullagh

    Professor   |     |  
      |   3/30/2021 9:49:32 PM
    Umi dissertation services writing dissertations
  • Sharwood

    Professor   |     |  
      |   6/9/2021 12:30:33 AM
    Fantastic blog! Do you have any tips for aspiring writers?
    I'm planning to start my own site soon but I'm a little lost on everything.
    Would you advise starting with a free platform like Wordpress or go for a
    paid option? There are so many choices out there that I'm totally confused ..
    Any tips? Thanks!
  • Donald

    Professor   |     |  
      |   5/30/2021 12:39:59 AM
    Magnificent site. A lot of helpful info here. I'm sending it to
    some pals ans additionally sharing in delicious. And of course, thanks for your sweat!
  • Donald

    Professor   |     |  
      |   5/2/2021 11:30:19 PM
    Orginal cialis cialis for sale in canada
  • Cranwell

    Professor   |     |  
      |   4/1/2021 4:23:32 PM
    Custom papers writing academic
    paper writing services
  • Fullarton

    Professor   |     |  
      |   5/27/2021 3:47:46 AM
    Excellent website. Lots of useful info here.

    I am sending it to several friends ans also sharing in delicious.
    And of course, thanks in your effort!
  • Millen

    Professor   |     |  
      |   5/17/2021 1:05:49 PM
    Hello, I want to subscribe for this web site to
    get latest updates, therefore where can i do it please help.
  • Fleischer

    Professor   |     |  
      |   6/14/2021 4:11:44 AM
    I go to see daily some web pages and information sites to read posts, but this web site presents feature based articles.
  • Tedeschi

    Professor   |     |  
      |   6/1/2021 11:10:34 AM
    Generic cialis 10mg low dose cialis cialis controlled substance
  • Cruce

    Professor   |     |  
      |   9/8/2021 6:11:36 PM
    Thanks for finally writing about >Academic Learning Of Urology Procedures - Robotic Ureteral Reimplant Psoas Hitch <Liked it!
  • Tennyson

    Professor   |     |  
      |   8/23/2021 1:17:03 PM
    Yes! Finally someone writes about antibiotics.
  • Feetham

    Professor   |     |  
      |   11/17/2020 12:01:42 PM
    Hello, i feel that i noticed you visited my blog so i came
    to return the desire?.I am attempting to in finding things to improve my website!I suppose its good
    enough to make use of a few of your concepts!!
  • Rehkop

    Professor   |     |  
      |   9/19/2021 12:57:05 AM
    What a information of un-ambiguity and preserveness of valuable knowledge concerning unexpected emotions.
  • Mudie

    Professor   |     |  
      |   4/7/2021 6:01:59 PM
    Prescription without a doctor's prescription pharmacy
    price comparison
  • Muscio

    Professor   |     |  
      |   8/31/2021 8:44:06 PM
    Thanks for the marvelous posting! I truly enjoyed
    reading it, you happen to be a great author.I
    will be sure to bookmark your blog and will come back from
    now on. I want to encourage you to continue your
    great writing, have a nice weekend!
  • Warnes

    Professor   |     |  
      |   12/13/2020 5:23:32 AM
    Free viagra viagra dosage for 70 year old
  • Lenehan

    Professor   |     |  
      |   11/21/2020 3:48:16 AM
    Sildenafil 50 price sildenafil india
  • Vanwinkle

    Professor   |     |  
      |   6/24/2021 9:38:09 PM
    That is a really good tip especially to those fresh to the blogosphere.
    Simple but very precise info… Thanks for sharing this one.
    A must read article!
  • Pohlman

    Professor   |     |  
      |   4/10/2021 12:33:05 AM
    Canada pharmacy online drug prices comparison drugs from canada with prescription
  • Dearing

    Professor   |     |  
      |   3/31/2021 8:00:09 PM
    Professional essay writers for hire i cant write my essay academic custom essays
  • Moir

    Professor   |     |  
      |   4/27/2021 7:24:24 PM
    Durée de l'effet du levitra levitra mg 10 levitra prices at walgreens
  • Leddy

    Professor   |     |  
      |   5/22/2021 9:55:04 PM
    generic professional bimatoprost trial samples of bimatoprost careprost alternative at walmart
  • Tenney

    Professor   |     |  
      |   6/15/2021 7:04:27 PM
    If some one wants to be updated with newest technologies after that he must be pay
    a visit this web site and be up to date every day.
  • Tighe

    Professor   |     |  
      |   4/4/2021 6:07:08 PM
    Generic cialis 30 pills 20mg prescription for cialis purchase
  • McIlwraith

    Professor   |     |  
      |   3/23/2021 2:42:34 PM
    Doctoral thesis database choosing a thesis topic thesis statement help
  • Mackellar

    Professor   |     |  
      |   12/13/2020 9:04:27 AM
    Where can i buy viagra viagra ingredients
  • Hood

    Professor   |     |  
      |   5/14/2021 11:19:20 AM
    Viagra 40 years old comprar viagra online
  • Hauck

    Professor   |     |  
      |   10/13/2020 7:47:17 AM
    If there is discharge coming from the penis then infection from bacteria, viruses or yeast is a possibility.

    Recently, they have achieved a pride of spot
    in the area of pharmaceutical. This risk list might be revised as more epidemiologic data opens up for now the high risk group includes: expectant women, young childrens.
  • Pearce

    Professor   |     |  
      |   9/9/2021 8:15:26 AM
    It's really a great and helpful piece of info. I'm satisfied
    that you simply shared this useful information with us.
    Please stay us informed like this. Thank you for
  • Bray

    Professor   |     |  
      |   5/27/2021 2:34:12 AM
    Post writing is also a fun, if you know after that you can write otherwise it
    is complex to write.
  • Caldwell

    Professor   |     |  
      |   9/9/2021 12:59:46 PM
    I used to be able to find good info from your content.
  • Baylis

    Professor   |     |  
      |   11/6/2020 5:01:51 AM
    Sometimes three weeks, days etc. viagra online cheapest price viagra 25mg
  • Hofmann

    Professor   |     |  
      |   12/13/2020 2:07:15 AM
    Viagra prank viagra or cialis
  • Llanos

    Professor   |     |  
      |   5/9/2021 11:31:46 PM
    buy hydroxychloroquine online
  • Otis

    Professor   |     |  
      |   5/13/2021 2:33:05 PM
    Nice response in return of this query with genuine arguments and describing the
    whole thing regarding that.
  • Kelleher

    Professor   |     |  
      |   6/9/2021 5:24:57 AM
    Pretty section of content. I just stumbled upon your blog and
    in accession capital to assert that I get in fact enjoyed account your blog posts.
    Any way I will be subscribing to your augment and even I achievement you access consistently quickly.
  • Funk

    Professor   |     |  
      |   7/31/2021 7:59:35 AM
    If some one desires expert view on the topic of blogging
    afterward i suggest him/her to visit this website, Keep up the good work.
  • Bromley

    Professor   |     |  
      |   4/12/2021 4:36:45 AM
    Us cialis online pharmacy cialis soft tablets
  • Castellano

    Professor   |     |  
      |   5/1/2021 4:26:18 AM
    trump's connection to hydroxychloroquine
  • Jaynes

    Professor   |     |  
      |   6/14/2021 10:29:38 AM
    Hmm it looks like your blog ate my first comment (it was
    extremely long) so I guess I'll just sum it up what I submitted and say, I'm thoroughly enjoying your blog.
    I as well am an aspiring blog blogger but I'm still new to everything.
    Do you have any suggestions for inexperienced blog writers?

    I'd really appreciate it.
  • Degotardi

    Professor   |     |  
      |   12/11/2020 11:10:45 PM
    Cialis pills cialis cost
  • Bittner

    Professor   |     |  
      |   6/1/2021 5:02:40 AM
    1 canadian pharmacy armour thyroid canada pharmacy best
    online pharmacy forum
  • Utter

    Professor   |     |  
      |   6/5/2021 9:01:26 PM
    I need to to thank you for this fantastic read!! I absolutely enjoyed every bit
    of it. I have you bookmarked to look at new things you post�
  • Martine

    Professor   |     |  
      |   10/7/2021 8:03:40 AM
    It's nearly impossible to find educated people in this particular topic, however, you sound
    like you know what you're talking about! Thanks
  • Catani

    Professor   |     |  
      |   5/28/2021 5:26:05 PM
    Do you have any video of that? I'd love to find
    out more details.
  • Isaacs

    Professor   |     |  
      |   5/26/2021 7:30:51 AM
    how to buy generic cialis
  • Villa

    Professor   |     |  
      |   3/23/2021 10:49:10 PM
    Best mba essay writing service original essay writing service
  • Oppen

    Professor   |     |  
      |   5/8/2021 5:43:45 AM
    continuously i used to read smaller articles which as well clear their motive,
    and that is also happening with this piece of writing which I am reading here.
  • Edgerton

    Professor   |     |  
      |   5/27/2021 10:33:47 AM
    Hello, this weekend is fastidious designed for me, as this occasion i am reading this impressive informative
    post here at my residence.
  • Coker

    Professor   |     |  
      |   5/31/2021 9:16:42 PM
    Generic cialis 30 pills 20mg cialis overnight online 20mg cialis not
  • Sweet

    Professor   |     |  
      |   11/20/2020 8:42:13 PM
    Viagra 200mg price price of viagra
  • Kilpatrick

    Professor   |     |  
      |   7/25/2021 12:10:51 PM
    I've been surfing on-line greater than 3 hours these days, yet I by
    no means found any fascinating article like yours. It is beautiful value enough for me.
    In my view, if all website owners and bloggers made excellent content material as you
    probably did, the web will be a lot more useful than ever
  • Marron

    Professor   |     |  
      |   7/13/2021 9:55:25 PM
    Your style is so unique in comparison to other people I've read stuff from.
    Many thanks for posting when you have the opportunity,
    Guess I will just book mark this web site.
  • Medeiros

    Professor   |     |  
      |   10/5/2021 12:24:23 PM
    I am genuinely grateful to the owner of this web page who has shared
    this impressive article at at this time.
  • Beals

    Professor   |     |  
      |   12/13/2020 12:35:22 AM
    What can i take to enhance cialis cialis
  • Lamaro

    Professor   |     |  
      |   6/29/2021 5:02:26 PM
    My family members always say that I am killing my time here at web,
    however I know I am getting knowledge everyday by reading thes pleasant content.
  • Dupree

    Professor   |     |  
      |   12/11/2020 2:15:55 PM
    Canadian pharmacy cialis 20mg cialis dosage
  • Sparks

    Professor   |     |  
      |   5/5/2021 5:29:13 AM
    over the counter generic cialis tadalafil 40 prescription tadalafil online
  • Maes

    Professor   |     |  
      |   12/14/2020 9:35:59 AM
    What's up mates, its enormous post about educationand
    entirely defined, keep it up all the time.
  • Champion de Crespigny

    Professor   |     |  
      |   3/29/2021 9:27:10 PM
    Mba essay writing service admission essay writing services
  • Vida

    Professor   |     |  
      |   6/1/2021 11:29:59 PM
    Wonderful blog! I found it while browsing on Yahoo News.
    Do you have any suggestions on how to get listed in Yahoo News?
    I've been trying for a while but I never seem to get there!
  • Aronson

    Professor   |     |  
      |   6/1/2021 10:08:50 AM
    Hi, i feel that i noticed you visited my blog thus i got here to return the desire?.I am trying to in finding things to improve my web site!I guess its adequate to make use of some of your
  • Bartley

    Professor   |     |  
      |   7/29/2021 3:26:47 AM
    This info is invaluable. When can I find out more?
  • Bristol

    Professor   |     |  
      |   12/11/2020 9:23:07 PM
    Buy viagra buy cialis
  • Rawlins

    Professor   |     |  
      |   12/2/2020 8:31:40 AM
    Buy essays online essays to buy
  • Earls

    Professor   |     |  
      |   6/10/2021 6:21:04 AM
    This paragraph will help the internet viewers for creating new website or even a blog from start
    to end.
  • Lancaster

    Professor   |     |  
      |   12/1/2020 10:42:42 AM
    Custom written essays custom english essays
  • Dotson

    Professor   |     |  
      |   5/27/2021 11:39:54 AM
    Oh my goodness! Incredible article dude! Thank you, However I am going through issues with your
    RSS. I don't know the reason why I can't subscribe to it.
    Is there anyone else having the same RSS issues?
    Anybody who knows the solution will you kindly respond?
  • Wallis

    Professor   |     |  
      |   10/30/2020 3:01:30 PM
    Edinburgh, Scotland, ISD Publications, 2000Herndon J, Strauss LT, Whitehead S,
    et al: Abortion surveillance—United States, 1998. cheapest viagra
  • Lions

    Professor   |     |  
      |   3/21/2021 4:53:57 PM
    Essay helper buy custom essays online
  • Glockner

    Professor   |     |  
      |   5/24/2021 10:26:06 PM
    Great beat ! I would like to apprentice while you amend your website, how could i subscribe for a weblog web site?
    The account aided me a acceptable deal. I had been tiny bit acquainted
    of this your broadcast provided bright transparent concept
  • Lynn

    Professor   |     |  
      |   12/22/2020 7:56:12 PM
    Aw, this was an exceptionally nice post. Finding the time
    and actual effort to generate a really good article… but what can I say… I hesitate a whole lot and don't manage to get nearly
    anything done.
  • O'Doherty

    Professor   |     |  
      |   2/28/2021 8:06:05 AM
    It's actually a great and useful piece of information. I am glad that you just shared this useful information with us.
    Please keep us informed like this. Thank you for sharing.
  • Popp

    Professor   |     |  
      |   2/17/2021 1:07:36 PM
    Greetings! Very useful advice within this article! It is the little
    changes that will make the greatest changes. Thanks a
    lot for sharing!
  • Akeroyd

    Professor   |     |  
      |   8/16/2021 1:16:40 AM
    Yes! Finally something about s128.
  • Poland

    Professor   |     |  
      |   11/5/2020 12:14:10 AM
    Signs and Symptoms of Mood Disorders — Lists the common signs and symptoms of depression and bipolar disorder. difference between generic viagra
    and viagra
  • Leave message

    Your rating:
    Security code