Ureterozystoneostomie nach der Psoas-Hitch-Technik - ,,Outside"-Variante

This paper presents the "outside" variant of the standard psoas hitch procedure. Two basic principles of the procedure are: lateralisation and fixation of the bladder at the psoas muscle; the long and straight reimplantation of the ureter on the posterior, lateral or anterolateral bladder wall using the extravesical approach. The main indications were the extensive changes of the ureter in case of neurogenic bladder dysfunction and the reduced bladder capacity with the changes of the mucous membrane. The procedure was also applied in those cases where the standard procedure would have been indicated. The advantages and disadvantages of the procedure in relation to the standard psoas hitch procedure are discussed. During 1982 to 1985 this procedure was applied in 67 cases. The age ranged from 2 months to 14 years. With 9 patients the operation was performed bilaterally. The time interval between the operations was from 3 to 6 months. Tailoring of the ureter was undertaken in 3 cases. The complications were: One ureter stenosis that was solved by means of the same technique, and three parahiatal diverticula formations without clinical manifestations.