Long‐term safety and efficacy of psoas bladder hitch in infants aged <12 months with unilateral obstructive megaureter

Abstract

Objective To determine the long‐term safety and efficacy of ureteric reimplantation with psoas bladder hitch (PBH) in patients aged <12 months with unilateral obstructive megaureter (OM). Patients and Methods We retrospectively compared a group of patients aged <12 months (study group) with an group of patients aged ≥12 months (comparison group), who underwent PBH for OM between September 2007 and April 2017, in terms of preoperative patient characteristics, intra‐ and peri‐operative results, and postoperative results. Results The study group comprised seven infants, five boys and two girls. The median (range) age at the time of PBH was 3 (2–8) months; OM was detected by ultrasonography during the fetal period. The left side was affected in four infants and the right side in three. Four infants had primary OM (POM). In all three infants who had ectopic OM in the complete double renal pelvis and ureter, the OM involved the ureter from the upper half of the kidney. The median (range) follow‐up period after PBH was 45 (33–129) months. Comparison of the two groups showed no significant difference in terms of surgical time (P = 0.948) and length of hospital stay (P = 0.125). In both groups, hydroureteronephrosis improved postoperatively in all patients. There was no significant difference between the two groups in terms of postoperative complications, such as vesico‐ureteric reflux, febrile urinary tract infection and deterioration of ipsilateral renal function. Notably, no patient underwent reoperation in either group. Conclusion Psoas bladder hitch for unilateral OM including POM appears to be safe and effective in the long term for patients aged <12 months and for those aged ≥12 months. Although not routinely recommended, PBH appears to be a viable option for selected infants with POM.

Minimally invasive ureteral reimplantation or endoscopic management for primary obstructive megaureter: a narrative review of technical modifications and clinical outcomes

“…The 5:1 ratio of the t unnel length to the ureteral diameter may be used as a guide for ef fect ive reimplantat ion (25). The psoas h itch and Boari f lap techniques can achieve a tension-free ureteroneocystostomy for inadequate ureteral length (26)(27)(28)(29)(30).…”