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.
A 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.
Seventy-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.
The 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.
BMC urology. 2019 Oct 24*** epublish ***
Frank Christoph, Franziska Herrmann, Peter Werthemann, Thomas Janik, Martin Schostak, Christian Klopf, Steffen Weikert
University of Urology, Otto-von-Guericke-Universität, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. ., Department of Urology, Vivantes Humboldt Klinikum Berlin, Am Nordgraben 2, 13509, Berlin, Germany., University of Urology, Otto-von-Guericke-Universität, Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.