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

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\u2009months in Bricker group and 17\u2009months in Wallace group. In both groups, the body mass index (BMI) was similar (26.1\u2009kg/m2 Bricker and 26.4\u2009kg/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\u2009=\u20090.001). In the Bricker group, patients with strictures had higher BMI (28.3 vs. 25.7\u2009kg/m2, p\u2009=\u20090.05). On average it took 8.5\u2009months in the Bricker group and three months in the Wallace group (p\u2009=\u20090.6) 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.