A comparison of the Bricker versus Wallace ureteroileal anastomosis in patients undergoing urinary diversion for bladder cancer. 2007

Erik Kouba, and Matt Sands, and Aaron Lentz, and Eric Wallen, and Raj S Pruthi
Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.

OBJECTIVE In recent years few studies have evaluated the success and complications of the 2 most common types of ureteroenteric anastomotic techniques, the Bricker and the Wallace anastomosis. We evaluated the complications of the Bricker and Wallace techniques of ureteroenteric anastomosis in a single surgeon, single institution series. METHODS From 2001 to 2005 a total of 186 patients underwent ileal conduit or ileal neobladder after cystectomy for bladder cancer. All patients were followed for a minimum of 12 months after surgery with complete clinical information. In all cases the ureters were anastomosed to a segment of ileum in a separate (Bricker) or conjoined (Wallace) fashion. RESULTS Of the 186 patients 94 underwent a Bricker (51%), 90 underwent a Wallace (48%) and 2 patients underwent both procedures (Wallace on duplicated system on 1 side, Bricker on contralateral side). Ureteral stricture developed in 5 of 186 (2.6%) patients and the overall stricture rate for all ureters was 7 of 371 (1.9%). In patients undergoing Bricker anastomosis the total stricture rate for all ureters was 3.7% (7 of 187). With the Wallace anastomosis the total stricture rate for all ureters was 0% (0 of 184). This difference in stricture rate in the Bricker vs Wallace subgroups was significant (p = 0.015). There was no difference in age, gender, creatinine, prior radiation, complications or mode of diversion between the groups. Body mass index was higher in the Bricker vs the Wallace group (29.0 vs 25.9 kg/m(2)). Of the 5 patients with strictures 1 underwent successful open repair, 1 had successful interventional radiological repair and 3 were treated with chronic ureteral stents (1 after failed open repair and 2 after failed radiological repair). CONCLUSIONS Both the Bricker and the Wallace anastomoses provide acceptably low stricture rates in a single surgeon case series. Indeed, the Wallace anastomosis had no strictures in this series. The Bricker group had a higher body mass index which was likely due to the often disparate ureteral lengths in obese patients after retrosigmoidal tunneling, which would have affected the choice of technique.

UI MeSH Term Description Entries
D007082 Ileum The distal and narrowest portion of the SMALL INTESTINE, between the JEJUNUM and the ILEOCECAL VALVE of the LARGE INTESTINE.
D008297 Male Males
D001749 Urinary Bladder Neoplasms Tumors or cancer of the URINARY BLADDER. Bladder Cancer,Bladder Neoplasms,Cancer of Bladder,Bladder Tumors,Cancer of the Bladder,Malignant Tumor of Urinary Bladder,Neoplasms, Bladder,Urinary Bladder Cancer,Bladder Cancers,Bladder Neoplasm,Bladder Tumor,Cancer, Bladder,Cancer, Urinary Bladder,Neoplasm, Bladder,Neoplasm, Urinary Bladder,Tumor, Bladder,Tumors, Bladder,Urinary Bladder Neoplasm
D003251 Constriction, Pathologic The condition of an anatomical structure's being constricted beyond normal dimensions. Stenosis,Stricture,Constriction, Pathological,Pathologic Constriction,Constrictions, Pathologic,Pathologic Constrictions,Pathological Constriction,Stenoses,Strictures
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000714 Anastomosis, Surgical Surgical union or shunt between ducts, tubes or vessels. It may be end-to-end, end-to-side, side-to-end, or side-to-side. Surgical Anastomosis,Anastomoses, Surgical,Surgical Anastomoses
D014517 Ureteral Obstruction Blockage in any part of the URETER causing obstruction of urine flow from the kidney to the URINARY BLADDER. The obstruction may be congenital, acquired, unilateral, bilateral, complete, partial, acute, or chronic. Depending on the degree and duration of the obstruction, clinical features vary greatly such as HYDRONEPHROSIS and obstructive nephropathy. Obstruction, Ureteral,Obstructions, Ureteral,Ureteral Obstructions
D014547 Urinary Diversion Temporary or permanent diversion of the flow of urine through the ureter away from the URINARY BLADDER in the presence of a bladder disease or after cystectomy. There is a variety of techniques: direct anastomosis of ureter and bowel, cutaneous ureterostomy, ileal, jejunal or colon conduit, ureterosigmoidostomy, etc. (From Campbell's Urology, 6th ed, p2654) Ileal Conduit,Conduit, Ileal,Conduits, Ileal,Diversion, Urinary,Diversions, Urinary,Ileal Conduits,Urinary Diversions

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