Bladder psoas hitch in hydronephrosis due to pelvic endometriosis: outcome of urodynamic parameters

Objective: To evaluate modifications in bladder sensitivity and function after ureteroneocystostomy with bladder psoas hitch for hydronephrosis due to deep pelvic endometriosis. Design: Prospective study. Setting: Center for the Treatment of Endometriosis of the Department of Obstetrics and Gynecology of the State University of Milan, Italy. Patient(s): Thirteen patients with deep endometriosis and ureteral involvement. Mean age of patients was 36.8 years (range, 31-48 years). Intervention(s): Ureteroneocystostomy with a psoas hitch. Indications for performing psoas hitch ureteroneocystostomy were severe hydronephrosis, radiologic evidence of ureteral stricture measuring >4 cm, and the impossibility of performing ureterolysis. Main Outcome Measure(s): impact on urodynamic parameters of bladder psoas hitch ureteroneocystostomy. Result(s): All patients showed normal bladder capacity 3 months after surgery. Two patients presented with stress incontinence immediately after surgery, which almost completely subsided at 3 months' follow-up. In 4 patients the bladder was also involved; in these cases a bladder resection was performed, followed by ureteral reimplantation. Follow-up was at 6 months from surgery and then every 6 months thereafter, in which patients underwent urogynecologic examination, completed a questionnaire on urinary symptoms, and underwent renal ultrasound evaluation with no evidence of recurrence of obstructive uropathy. Conclusion(s): On the basis of the results of the present study, bladder psoas hitch along with ureteral resection and ureteroneocystostomy for infiltrating endometriosis do not seem to have a negative impact on urodynamic parameters. (Fertil Steril (R) 2009;92:35-40. (C)2009 by American Society for Reproductive Medicine.)