Groen V H, Lock M T W T, de Angst I B, Verhagen P C M S, Horenblas S, Dik P, Bosch J L H R
Department of Urology University Medical Centre Utrecht Utrecht The Netherlands.
Department of Urology Erasmus University Medical Centre Rotterdam Rotterdam The Netherlands.
BJUI Compass. 2021 Apr 6;2(5):331-337. doi: 10.1002/bco2.85. eCollection 2021 Sep.
To present the short-term and long-term outcomes of the psoas hitch procedure in a large cohort with long-term follow-up.
A multicenter, retrospective cohort study was conducted. Patients were included if they had undergone an open psoas hitch procedure with ureteral reimplantation for different types of distal ureteral pathology between 1993 and 2017. Clinical failure was defined as radiologically-proven obstruction of the ureteroneocystostomy and/or post-operative complaints requiring additional surgery. Pre-operative demographic data and post-operative radiological imaging were collected. Complications were categorized as peri-operative, acute (<30 days), and long-term complications.
A total of 166 patients had undergone a psoas hitch procedure, with a median follow-up of 15 months (IQR 6-45). Indications for the procedure included intra-operative injury of the ureter during gynecological, urological or general surgery, transitional cell carcinoma of the distal ureter, fistulae, (radiation) fibrosis, and trauma. There was no significant difference in pre- and post-operative estimated glomerular filtration rate. Post-operative complications included urinary leakage, recurrent urinary tract symptoms, recurrent malignancy, and kidney failure. Postoperative imaging was available in 143 patients. Failure of the psoas hitch procedure was seen in 8% (11/143) of the patients. In 55% (6/11) of these patients, radiation fibrosis was the indication for the psoas hitch procedure.
This study provides greater insight into the long-term complications of the open psoas hitch procedure in adults. The psoas hitch procedure can be considered a safe procedure for restoring the continuity of the ureter for different types of ureteral pathologies in adult patients. However, patients with a history of radiation therapy causing retroperitoneal fibrosis might be more prone to failure after the procedure.
呈现长期随访的大型队列中腰大肌悬吊术的短期和长期结果。
开展了一项多中心回顾性队列研究。纳入1993年至2017年间因不同类型远端输尿管病变接受开放性腰大肌悬吊术联合输尿管再植术的患者。临床失败定义为经影像学证实的输尿管膀胱吻合口梗阻和/或需要再次手术的术后主诉。收集术前人口统计学数据和术后影像学资料。并发症分为围手术期、急性（<30天）和长期并发症。
共有166例患者接受了腰大肌悬吊术，中位随访时间为15个月（四分位间距6 - 45个月）。该手术的适应证包括妇科、泌尿外科或普外科手术中输尿管的术中损伤、远端输尿管移行细胞癌、瘘管、（放射性）纤维化和创伤。术前和术后估计肾小球滤过率无显著差异。术后并发症包括尿漏、复发性尿路症状、复发性恶性肿瘤和肾衰竭。143例患者有术后影像学资料。143例患者中有8%（11/143）出现腰大肌悬吊术失败。在这些患者中，55%（6/11）的手术适应证为放射性纤维化。
本研究更深入地了解了成人开放性腰大肌悬吊术的长期并发症。对于成年患者不同类型的输尿管病变，腰大肌悬吊术可被视为恢复输尿管连续性的安全手术。然而，有放疗导致腹膜后纤维化病史的患者术后可能更容易失败。
