Multi-Institutional Evaluation of Bladder Elongation Psoas Hitch (BEPH): A Safe and Durable Solution for Mid to Distal Ureteral Strictures

Introduction We present 10-year experience and patient outcomes for the bladder elongation with psoas hitch (BEPH) procedure for mid to distal ureteral strictures. Methods We reviewed all adult patients undergoing BEPH for ureteral stricture disease between 2013 and 2024. The primary outcome was procedural success, defined as no need for further intervention for stricture (redo repair, nephrectomy, nephrostomy tube or stent). The secondary outcome was change in AUA Symptom Scores (AUASS). Results A total of 108 patients underwent surgery during this time, 70 patients met inclusion criteria, with a median age at surgery of 54 years (IQR 43–63). 20 patients (28.5%) had previous radiation therapy, 61 (87%) had prior abdominal surgery, and 30 (42.9%) had prior failed management. Median length of stay was 2 days (IQR 1–4), with 34 (48.6%) of patients leaving by postoperative day 1. Median length of follow-up was 34 months (IQR 21–58). Overall procedural success rate was 98.5% (69/70), with one patient requiring a redo reimplant. Analysis of AUA Symptom scores showed no difference in individual symptom domains, with significant improvement in the mean pre- and postoperative AUA total score (p = 0.03) and Quality of Life score (p < 0.01). Conclusion Bladder elongation with psoas hitch is a durable solution with a high success rate and limited morbidity for patients with a mid-to-distal ureteral stricture. Despite altering bladder morphology, BEPH significantly improves quality of life scores, and is not associated with worsening bladder symptom scores.