Technique Selection of Bricker or Wallace Ureteroileal Anastomosis in Ileal Conduit Urinary Diversion: A Strategy Based on Patient Characteristics

Abstract

This study was designed to establish an individualized selection strategy for the two most common types of ureteroenteric anastomotic techniques (Bricker and Wallace anastomosis) used in ileal conduit (IC) diversion. Patients who underwent IC diversion after radical cystectomy for transitional cell carcinoma between January 2009 and December 2011 were prospectively collected. The choice of anastomosis type (Bricker vs. Wallace) was successively based on tumor characteristics, ureteral anomalies, and ureteral length after retrosigmoidal tunneling. Ninety-nine patients were enrolled in the final study. Fifty-three patients underwent Bricker anastomosis, and 46 underwent Wallace anastomosis. Ureteral stricture developed in 6 (6.1%) patients and the overall stricture rate for all ureters was 3.1% (6/196). Strictures occurred at an average of 13.3 months after surgery and were predominately located in the left ureter (66.7%, 4/6). The difference in the ureter stricture rates between the two groups was not statistically significant: 3.8% (4/104) and 2.2% (2/92) for Bricker and Wallace, respectively (p=0.686). There were no significant differences in age, sex, body mass index (BMI), prevalence of pelvic radiation therapy, length of stay, follow-up time, or time to stricture between the two techniques. Patients in whom stricture developed had a significantly higher mean BMI compared with those without stricture (25.2 vs. 23.3 kg/m(2), respectively; p=0.008). Our preliminary outcomes demonstrate that this selection strategy of Bricker vs. Wallace anastomosis seems to be clinically reliable, providing an acceptable low ureteral stricture rate of 3.1%. However, the potential advantage for oncologic control of this strategy is needed to further confirm.