[Psoas fixation of the bladder. An efficient aid in cases of repeat surgery of the uretero-vesical junction].

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.