What is a "psoas hitch"?
A psoas hitch is a method of adapting to a long distal ureteral injury. In a psoas hitch, the bladder dome is pulled toward the damage ureter to try to physically close the gap between bladder and undamaged ureter. A ureteral re-implantation on the bladder wall is then performed.
Scout radiograph: Numerous clips in the pelvis from TAH/BSO for a malignant uterine tumour. Left double-J ureteral stent. There is also a left iliac artery stent and a left lower quadrant colostomy. On the second coned-in scout radiograph, a round opacity at the level of the symphysis pubis represents a Foley balloon.
Cystogram: Contrast is introduced through a Foley catheter in the bladder. The bladder is deformed because of a psoas hitch. On progressive images, there is a wisp of contrast extending from the bladder into the left pelvis, compatible with a bladder leak. No vesicoureteral reflux.