AB005. SOH25_AB_287. Open re-do ureteric re-implantation with psoas hitch

Background: The technique of ureteric re-implantation with psoas bladder hitch has belonged to the toolkit of reconstructive urologic surgery for over a century and is considered an excellent method to restore the urinary tract continuity in patients presenting defects of the lower ureter of different etiologies. Primary obstructive megaureter presents with flank pain, recurrent urinary tract infections (UTIs), hematuria, urolithiasis, and even loss of renal function. Open ureteric re-implantation has shown an excellent success rate of nearly 90% and remained the gold standard treatment for symptomatic obstructive megaureter. However, redo reconstructive surgery has always represented a challenge due to various reasons.

Methods: In this video, we are demonstrating step-by-step open left ureteric re-implantation with psoas hitch and adhesiolysis for a patient who had the primary procedure done as a child and presented again in their thirties with symptoms. Investigations confirmed ureteric obstruction and deteriorated kidney split function. We aim to show the challenges that may arise in these cases, and how to deal with them.

Results: Ureteral re-implantation aims to excise the narrow ureteral segment with or without tailoring the ureter to the appropriate size by tapering or plication and to anastomose the distal ureter to the bladder with an anti-reflux submucosal tunnel or ureteral nipple.

Conclusions: The video developed is a valuable teaching resource, that will help trainees to understand ureteric re-implantation, extraperitoneal approach, and the difficulties which may arise.

Keywords: Ureteric reimplantation; psoas hitch; megaureter; reconstruction; extraperitoneal approach