1. Bricker versus Wallace ureteroileal anastomosis: A multi‐institutional propensity score‐matched analysis.
- Author
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Al‐Nader, Mulham, Krafft, Ulrich, Hess, Jochen, Kesch, Claudia, AbdelRazek, Mostafa, Abolyosr, Ahmad, Alsagheer, Gamal A., Mohamed, Omar, Fathi, Atef, Tschirdewahn, Stephan, Hadaschik, Boris A., and Mahmoud, Osama
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RADIOTHERAPY , *URINARY diversion , *ABDOMINAL surgery , *BODY mass index - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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