BERKELEY, CA (UroToday Inc.) - Urinary diversion following radical cystectomy requires ureteral reimplantation. For ileal conduits and low-pressure continent diversions, this is often a refluxing reimplantation. The Bricker technique is commonly used, and surgeons may use either interrupted or running anastomotic sutures. In either case, it can seem to be a time consuming part of the procedure.

Dr. Lee and colleagues at the University of Michigan in Ann Arbor sought to compare their modified Taguchi "single-stitch" (SS) technique to the classic Bricker anastomosis. They hoped to find a quicker method without increased evidence of complications. Their findings are reported in the November 2004 issue of Urology.

Over a nine-month period one senior urologic oncologist performed 75 radical cystectomies with either ileal conduit or orthotopic urinary diversion. The first 36 patients had a Taguchi SS technique performed; the next 39 had a Bricker anastomosis. There was no randomization, and data was reviewed retrospectively.

The Taguchi SS technique consisted of a single 3-0 Vicryl suture placed from the distal end of the ureter up through the intestinal wall, 1-2 cm from the enterotomy site. The Bricker anastomosis uses approximately 8 interrupted 5-0 Monocryl sutures. A second layer of interrupted 5-0 Prolene sutures is used to join the ureteral adventitia and ileal serosa in both techniques.

Standard clinical, demographic and surgical outcomes were reviewed. Upper tract imaging was performed at 4-6 weeks after cystectomy, yearly and more often if clinically indicated. Orthotopic neobladder reconstruction or ileal conduit diversions were used in the Bricker (23 and 16 patients, respectively) and Taguchi SS (24 and 12 patients, respectively). The only significant difference between the two groups was a higher percentage of organ-confined disease in the patients receiving a Bricker anastomosis.

Ureteral complications occurred in 6 Taguchi SS and 3 Bricker patients, respectively. Patients in the Taguchi SS group showed 4 ureteral strictures and 2 developed anastomotic leaks. Most were managed with interventional techniques. Patients in the Bricker group experienced no ureteral leaks but 3 developed ureteral strictures. Only one required open surgery. The other 2 had interventional dilatation. Overall ureteral complication rates were not statistically different.

Durations required to perform the anastomoses were surprisingly not measured, as this was to be the primary observation of the study. Overall operative times did not differ. While the authors conclude that one should be hesitant before changing from classic Bricker techniques, due to lack of benefit with the Taguchi technique, their data showed no statistical difference in complications. The study is limited by its lack of data to answer the primary hypothesis, by lack of randomization and by their addition of a second suture layer to the original "single-stitch" technique, thus no longer allowing it to be a "single-stitch".

Urology 2004;64:940-944