Abstract
ObjectiveTo describe and illustrate a novel technique of uretero-ileal anastomosis for use in urinary diversion – the Pull-through Anastomosis of Ureter To Enteric Conduit (PAUTEC). A second objective was to evaluate the surgical outcomes of the PAUTEC anastomosis. Materials and MethodsOur novel anastomotic technique was described step-by-step and visually depicted with illustrations and the accompanying narrated video. Additionally, to evaluate safety and efficacy, a retrospective review of a prospectively maintained database was performed. Patients who underwent radical cystectomy alone or during pelvic exenteration, with ileal conduit diversion incorporating PAUTEC, 2016-2020 with ≥6 months follow-up were included. Surgical outcomes and renal function were analysed. ResultsPAUTEC anastomosis was performed on 43 ureters in 23 patients. Mean age was 66 years [50-80] and 21 of 23 patients were male. One patient had a conservatively-managed small urine leak. No ureteric strictures have been identified to date. Mean serum creatinine was 1.15 mg/dL [0.69-2.08] (102umol/L, range 61-184 umol/L) preoperatively, and 1.09 mg/dL [0.61-2.59] (96.3 umol/L, range 54-229 umol/L) at follow-up, demonstrating no significant change (P= .26, paired t-test). Mean follow-up was 15 months [6-44]. ConclusionA PAUTEC technique of uretero-ileal anastomosis is feasible and technically straightforward, with satisfactory outcomes observed to date.
Highlights
Radical cystectomy with pelvic lymphadenectomy is the gold-standard treatment for localized muscle-invasive bladder cancer in eligible patients
Patients who had undergone radical cystectomy, either alone or as part of pelvic exenteration, with ileal conduit diversion incorporating Pull-through Anastomosis of Ureter To Enteric Conduit (PAUTEC) technique were eligible for inclusion
The PAUTEC (Pull-through Anastomosis of Ureter To Enteric Conduit) technique of uretero-ileal anastomosis was successfully completed on all ureters in this study
Summary
Data Acquisition and Analysis A retrospective review of a prospectively maintained radical cystectomy database in an academic teaching hospital was performed. Patients who had undergone radical cystectomy, either alone or as part of pelvic exenteration, with ileal conduit diversion incorporating PAUTEC technique were eligible for inclusion. Those whose surgery was performed over the time period 2016-2020, and in whom at least 6 months follow-up data was available, were included in final analysis. Primary outcome measures were technical feasibility and anastomosis-related surgical complications. Secondary outcomes included pre and postoperative renal function and evidence of uretero-ileal stricture at medium-term follow-up.
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