Rodó Salas J, Martín Hortigüela E, Salarich de Arbell J
Servicio de Cirugía, Hospital Infantil San Juan de Dios, Barcelona, España.
Arch Esp Urol. 1991 Mar;44(2):125-9.
We reviewed our experience with 6 patients (5 males, 1 female) aged 3 to 10 years in whom psoas hitch of the bladder was performed in the course of repeated surgery of the vesicoureteral junction. All patients had previously undergone an operation on the distal ureter and presented an evident shortening of its length. After ureteral reimplantation in 4 patients (3 were Hendren's procedure and 1 Cohen's reimplantation), the reflux either persisted or became worse and the remaining 2 patients (posterior urethral valves) underwent cutaneous distal ureterostomy. In all cases the psoas hitch procedure successfully resolved the ureteral defect, provided the bladder with a new surface for a submucosal tunnel of suitable length and diameter, and permitted reimplantation of the ureter without traction or possibility of bending. The psoas hitch procedure is a simple and effective alternative in the management of distal ureter length defects. Although it has precise indications, it can have broad applications when combined with other techniques (TUU). However, the approach should be one of caution in those cases that also require surgery of the contralateral distal ureter.
我们回顾了6例年龄在3至10岁的患者（5例男性，1例女性）的治疗经验，这些患者在膀胱输尿管连接部的重复手术过程中进行了膀胱腰大肌固定术。所有患者此前均接受过远端输尿管手术，且输尿管长度明显缩短。4例患者（3例行亨德伦手术，1例行科恩再植术）行输尿管再植术后，反流持续存在或加重，其余2例患者（后尿道瓣膜）行皮肤远端输尿管造口术。在所有病例中，腰大肌固定术成功解决了输尿管缺损问题，为膀胱提供了一个新的表面，用于构建长度和直径合适的黏膜下隧道，并允许输尿管再植而无需牵引或弯曲。腰大肌固定术是处理远端输尿管长度缺损的一种简单有效的替代方法。尽管它有明确的适应证，但与其他技术（TUU）联合使用时可广泛应用。然而，在那些也需要对侧远端输尿管手术的病例中，应谨慎采用该方法。
