Hybrid Ureteroenteric Anastomosis Is Associated With Lower Stricture Rates in Ileal Conduit Urinary Diversion
Abstract
Background Anatomic complications of the ureteroenteric anastomosis in ileal conduit (IC) cause significant
morbidity in patients post-cystectomy and cystoprostatectomy. The Bricker technique has a perceived disadvantage
of increased risk for stricture, whereas the Wallace technique runs the risk for ureteral malignancy affecting both
ureteric ends, and bilateral ureteric obstruction from a stone lodged at the anastomosis. We aimed to evaluate
the safety, efficacy, and stricture rate of a novel hybrid ureteroenteric anastomosis technique. We compared these
outcomes to the Bricker and Wallace anastomosis techniques for IC urinary diversion (ICUD).
Methods We performed a retrospective chart review of patients who had undergone ICUD after cystectomy for
bladder cancer from 2011 to 2016. Patients were categorized into groups undergoing the Bricker, Wallace, and hybrid
ureteroanastomosic techniques. Strictures were identified during clinical follow-up or hospital presentations with
complications.
Results We identified 68 patients suitable for inclusion. They were separated by Bricker, Wallace, and hybrid
anastomosis techniques, with 19 (27.9%), 20 (29.4%), and 29 (42.6%) patients, respectively. Ureteroenteric anastomotic
strictures occurred in 9 patients (5 Bricker, 3 Wallace, 1 hybrid). This difference in stricture rates for Bricker versus
hybrid (26.3% vs. 3.4%; OR, 10 [95% CI, 1.1 to 121.1]; P = 0.02) was significant but was comparable for Wallace
versus hybrid (15.0% vs. 3.4%; OR, 4.9 [0.7 to 66.0]; P = 0.15) and for Bricker versus Wallace (26.3% vs. 15.0%;
OR, 2 [0.4 to 8.6]; P = 0.87). 15 patients (51%) in the hybrid group required oral antibiotics for a symptomatic urinary
tract infection compared with 4 (21%) with Bricker and 8 (40%) with Wallace (P = 0.10). Median post-cystectomy
follow-up and stricture formation time were 16 months (IQR, 4–36) and 9 months (7–32), respectively.
Conclusion The hybrid technique is a safe and efficacious alternative to the Bricker and Wallace anastomoses.
It carries with it a risk for urinary tract infection that is eclipsed by substantially lowered rates of ureteric strictures
requiring intervention while maintaining the advantage of separating the two ureters.
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