Hybrid Ureteroenteric Anastomosis Is Associated with Lower Stricture Rates in Ileal Conduit Urinary Diversion
BackgroundAnatomic 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...
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| Format: | Article |
| Language: | English |
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The Société Internationale d’Urologie (SIU)
2023-05-01
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| Series: | Société Internationale d’Urologie Journal |
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| Online Access: | https://siuj.org/index.php/siuj/article/view/262/210 |
| _version_ | 1797372229315461120 |
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| author | Spencer H. Bell Zein Alhamdani Kirby R. Qin Vidyasagar Chinni Scott Donellan Damien Bolton Marlon Perera Dixon Woon |
| author_facet | Spencer H. Bell Zein Alhamdani Kirby R. Qin Vidyasagar Chinni Scott Donellan Damien Bolton Marlon Perera Dixon Woon |
| author_sort | Spencer H. Bell |
| collection | DOAJ |
| description | BackgroundAnatomic 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).
MethodsWe 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.
ResultsWe 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.
ConclusionThe 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. |
| first_indexed | 2024-03-08T18:32:49Z |
| format | Article |
| id | doaj.art-808118f2b6d54657933c88249ccd42e0 |
| institution | Directory Open Access Journal |
| issn | 2563-6499 |
| language | English |
| last_indexed | 2024-03-08T18:32:49Z |
| publishDate | 2023-05-01 |
| publisher | The Société Internationale d’Urologie (SIU) |
| record_format | Article |
| series | Société Internationale d’Urologie Journal |
| spelling | doaj.art-808118f2b6d54657933c88249ccd42e02023-12-29T21:46:38ZengThe Société Internationale d’Urologie (SIU)Société Internationale d’Urologie Journal2563-64992023-05-014317117910.48083/SZDP5651Hybrid Ureteroenteric Anastomosis Is Associated with Lower Stricture Rates in Ileal Conduit Urinary DiversionSpencer H. BellZein Alhamdani Kirby R. QinVidyasagar ChinniScott Donellan Damien BoltonMarlon PereraDixon WoonBackgroundAnatomic 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). MethodsWe 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. ResultsWe 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. ConclusionThe 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.https://siuj.org/index.php/siuj/article/view/262/210ileal conduiturinary diversionbrickerwallacehybridstrictureretrospective |
| spellingShingle | Spencer H. Bell Zein Alhamdani Kirby R. Qin Vidyasagar Chinni Scott Donellan Damien Bolton Marlon Perera Dixon Woon Hybrid Ureteroenteric Anastomosis Is Associated with Lower Stricture Rates in Ileal Conduit Urinary Diversion Société Internationale d’Urologie Journal ileal conduit urinary diversion bricker wallace hybrid stricture retrospective |
| title | Hybrid Ureteroenteric Anastomosis Is Associated with Lower Stricture Rates in Ileal Conduit Urinary Diversion |
| title_full | Hybrid Ureteroenteric Anastomosis Is Associated with Lower Stricture Rates in Ileal Conduit Urinary Diversion |
| title_fullStr | Hybrid Ureteroenteric Anastomosis Is Associated with Lower Stricture Rates in Ileal Conduit Urinary Diversion |
| title_full_unstemmed | Hybrid Ureteroenteric Anastomosis Is Associated with Lower Stricture Rates in Ileal Conduit Urinary Diversion |
| title_short | Hybrid Ureteroenteric Anastomosis Is Associated with Lower Stricture Rates in Ileal Conduit Urinary Diversion |
| title_sort | hybrid ureteroenteric anastomosis is associated with lower stricture rates in ileal conduit urinary diversion |
| topic | ileal conduit urinary diversion bricker wallace hybrid stricture retrospective |
| url | https://siuj.org/index.php/siuj/article/view/262/210 |
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