Ureteroenteric strictures: a single center experience comparing Bricker versus Wallace ureteroileal anastomosis in patients after urinary diversion for bladder cancer

Frank Christoph,Steffen Weikert,Peter Werthemann,Christian Klopf,Thomas Janik,Franziska Herrmann,Martin Schostak

doi:10.1186/s12894-019-0529-6

Frank Christoph, Steffen Weikert + Show 5 more

Open Access

https://doi.org/10.1186/s12894-019-0529-6

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Abstract

BackgroundTo evaluate the outcome and complication rate in a single institution experience using the two most commonly used techniques of ureteroenteric anastomosis, the Bricker and Wallace anastomosis.MethodsA total of 137 patients underwent ileal conduit for bladder cancer. Ureters were anastomosed by two experienced surgeons, one performing a Bricker and the other, a Wallace anastomosis. Stricture was identified during clinical follow-up.ResultsSeventy-five patients underwent a Bricker anastomotic, and 65 received a Wallace anastomosis. The average age was 70 in both groups, males were predominant (66% Bricker, 70% Wallace). Follow up period was 36.5 months in Bricker group and 17 months in Wallace group. In both groups, the body mass index (BMI) was similar (26.1 kg/m2 Bricker and 26.4 kg/m2 Wallace). We observed that the stricture rate after performing the Bricker anastomosis technique was 25.3% (19/75) as compared to 7.7% (5/65) after Wallace anastomosis technique, which was statistically significant (p = 0.001). In the Bricker group, patients with strictures had higher BMI (28.3 vs. 25.7 kg/m2, p = 0.05). On average it took 8.5 months in the Bricker group and three months in the Wallace group (p = 0.6) to develop stricture.ConclusionsThe stricture rate was significantly higher when Bricker technique was applied. Although the BMI was not different in both groups, patients with a higher BMI were more likely to develop stricture. We believe that the approach of the separate and refluxing technique of Bricker anastomosis especially in obese patients poses a higher risk for anastomotic stricture formation.

Highlights

To evaluate the outcome and complication rate in a single institution experience using the two most commonly used techniques of ureteroenteric anastomosis, the Bricker and Wallace anastomosis
Bricker in 1956 whereas David Wallace described his technique in the British Journal of Urology in 1966 [6, 7]
The local database was reviewed for patients who underwent radical cystectomy and had either Bricker or Wallace ureterenteric anastomosis performed on them

Summary

Introduction

To evaluate the outcome and complication rate in a single institution experience using the two most commonly used techniques of ureteroenteric anastomosis, the Bricker and Wallace anastomosis. Bladder cancer is the second most common malignancy of urological cancers. Only one third of these patients will have muscle invasive disease and subsequent radical cystectomy with urinary diversion [2]. The commonly used types of urinary diversion involve a segment of. The most commonly used forms of ureteroenteric anastomosis techniques are the Bricker (separate) and Christoph et al BMC Urology (2019) 19:100 the Wallace (conjoined) anastomosis. The Bricker anastomosis was first described by Eugene M. Bricker in 1956 whereas David Wallace described his technique in the British Journal of Urology in 1966 [6, 7]. There have only been four publications and one meta-analysis that evaluate the benefits and harms of each implantation strategy of the ureter [8–12]

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