1. Bricker versus Wallace ureteroileal anastomosis: A multi-institutional propensity score-matched analysis.
- Author
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Al-Nader M, Krafft U, Hess J, Kesch C, AbdelRazek M, Abolyosr A, Alsagheer GA, Mohamed O, Fathi A, Tschirdewahn S, Hadaschik BA, and Mahmoud O
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Constriction, Pathologic etiology, Postoperative Complications etiology, Postoperative Complications epidemiology, Ureteral Obstruction surgery, Ureteral Obstruction etiology, Treatment Outcome, Follow-Up Studies, Propensity Score, Anastomosis, Surgical adverse effects, Urinary Diversion adverse effects, Urinary Diversion methods, Ureter surgery, Ileum surgery
- Abstract
Aim of the Study: The 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 Methods: A 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., Results: Overall, 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., Conclusion: The 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., (© 2024 The Japanese Urological Association.)
- Published
- 2024
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