A Modified Ureteroileal Anastomosis Technique for Bricker Urinary Diversion

Abstract

Up to 10% of patients who have undergone the Bricker ileal conduit urinary diversion may develop ureteroileal anastomotic complications that are more frequently associated with the left side ureter. We have therefore modified the standard Bricker ileal conduit technique to minimize the anastomotic complications associated with the left side ureter. In our modification, the proximate end of the ileal conduit was brought from the right side to the left under the mesosigmoid in an isoperistaltic fashion. The left ureter that remained in the natural extraperitoneal location was anastomosed to the ileal segment in the usual end-to-side fashion without the need of extensive ureteral dissection. A series of 42 patients have undergone ileal conduit urinary diversion using this modified technique. During a median follow-up period of 18.6 months, this technique was found to have no associated major perioperative complications and early- and intermediate-term ureteroileal anastomotic complications from both sides of the ureters. Our modified ileal conduit diversion technique was easy and safe to perform, and may serve as an alternative technique for the standard Bricker ileal conduit urinary diversion, especially when the left distal ureter was involved extensively with urothelial carcinoma.