Psoas Hitch

In 1969, Turner-Warwick and Worth7 described a means to replace length lost in the lower third of the ureter by bringing the bladder up to the level of the defect and affixing it to the psoas muscle and/or fascia. The bladder is mobilized from its lateral attachments as much as possible. The vas deferens or round ligament can also be divided to gain additional mobility. With these maneuvers, the bladder dome may be brought as high as the iliac vessels. A small, contracted bladder is a relative contraindication to a psoas hitch because of the difficulty in attaining adequate mobility. It is then preferably fixed to the psoas minor tendon with several absorbable sutures. Alternatively, the psoas muscle will often suffice with care taken to place the sutures longitudinally so as to not injure the genitofemoral nerve. A ureteroneocystostomy is then performed and a Foley catheter and pelvic drain are left in place. A double-J stent should be left in place as well.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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