The need to pass the distal left ureter under the mesosigmoid can require extensive dissection, in order to allow a tension-free ureteroileal anastomosis. This can sometimes lead to a compromised blood supply of the left ureter, resulting in a higher incidence of delayed ischemic damage, which is the most common cause of uretero-enteric stricture. The common percentage of uretero-enteric stricture reported in the literature is 1.7- 14%, being more common on the left side. Of interest, is the fact that no significant difference is been reported in strictures occurrence rate between Bricker and Wallace types of anastomosis.
These strictures are difficult to treat, have a high risk of recurrence, and may lead to renal function deterioration. The authors present their results with a modified ileal conduit technique (MICT) and left ileo-ureteral anastomosis aimed to prevent uretero-ileal strictures.
This novel technique involves preparation of an ileal conduit of 20 cm length. The proximal end of the ileal conduit tract was brought to the left side through the meso-sigmoid and was fixed to the parietal peritoneum, to avoid an extensive dissection and mobilization of the left ureter and to perform a tension free anastomosis. On the right side, the authors performed a classical Bricker uretero-ileal anastomosis, while on the left side the ureter was sutured directly to the end of ileal conduit.
Between 2001 and 2010, 98 consecutive patients underwent radical cystectomy with ileal conduit diversion with classical Bricker anastomotic technique. Later on, from 2011 to 2015, 46 consecutive patients underwent the procedure with the authors’ new technique (MICT).
The MICT was easily performed in all cases, leading to neither intraoperative nor postoperative complications, without increasing intraoperative time. The ileo-ureteral stricture rate was 9.1% (8/98 patients, 1/8 patients with bilateral stricture) in those operated with the traditional technique; while no patient had a ureteral stricture with the modified technique.
The authors concluded that the MICT technique shows very promising results; and further randomized studies with a larger cohort are needed to confirm these results.
Presented by: Mari M
Affiliation: Urology Division, Agnelli Hospital Pinerolo, Torino, Italy
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal