Bricker versus Wallace ureteroileal anastomosis: A multi‐institutional propensity score‐matched analysis

Author:

Al‐Nader Mulham1,Krafft Ulrich1ORCID,Hess Jochen1,Kesch Claudia1,AbdelRazek Mostafa2ORCID,Abolyosr Ahmad2,Alsagheer Gamal A.2,Mohamed Omar2,Fathi Atef2,Tschirdewahn Stephan1,Hadaschik Boris A.1,Mahmoud Osama12ORCID

Affiliation:

1. Department of Urology University Hospital Essen Essen Germany

2. Department of Urology, Qena Faculty of Medicine South Valley University Qena Egypt

Abstract

Aim of the studyThe aim of our study is to evaluate the difference in stricture rate between matched groups of Bricker and Wallace techniques for ureteroileal anastomosis.Patients and methodsA retrospective analysis of patients undergoing urinary diversion (UD) with Bricker and Wallace ureteroileal anastomosis at two university hospitals. Two groups of Bricker and Wallace patients were matched in a 1:1 ratio based on the age, sex, body mass index (BMI), Charlson comorbidity index (CCI), preoperative hydronephrosis, prior radiation therapy or abdominal surgery, pathologic T and N stages and 30‐days‐Clavien grade complications≥III. A multivariable Cox regression analysis was conducted to identify predictors of ureteroenteric stricture (UES) in all patients.ResultsOverall, 740 patients met the inclusion criteria and 209 patients in each group were propensity matched. At a similar median follow‐up of 25 months, UES was detected in 25 (12%) and 30 (14.4%) patients in Bricker and Wallace groups, respectively (p = 0.56). However, only one patient in the Bricker group developed a bilateral stricture compared to 15 patients in the Wallace group, resulting in a significantly higher number of affected renal units in the Wallace group: 45 (10.7%) versus only 26 (6.2%) in the Bricker group (p = 0.00). On multivariable extended Cox analysis, prior radiotherapy, presence of T4 pelvic malignancy and nodal positive disease were independent predictor of UES formation.ConclusionThe technique of ureteroileal anastomosis itself does not increase the rate of stricture; however, conversion of two renal units into one is associated with a higher incidence of bilateral upper tract involvement.

Publisher

Wiley

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