Comparative analysis of Bricker versus Wallace ureteroenteric anastomosis and identification of predictors for postoperative ureteroenteric stricture
© 2021. The Author(s)..
PURPOSE: Ureteroenteric anastomosis after cystectomy is usually performed using the Bricker or Wallace technique. Deterioration of renal function is the most common long-term complication of urinary diversion (UD). To improve surgical care and optimize long-term renal function, we compared the Bricker and Wallace anastomotic techniques and identified risk factors for ureteroenteric strictures (UES) in patients after cystectomy.
MATERIAL AND METHODS: Retrospective, monocentric analysis of 135 patients who underwent cystectomy with urinary diversion at the University Hospital Essen between January 2015 and June 2019. Pre- and postoperative renal function, relevant comorbidities, prior chemo- or radiotherapy, pathological findings, urinary diversion, postoperative complications, and ureteroenteric strictures (UES) were analyzed.
RESULTS: Of all 135 patients, 69 (51.1%) underwent Bricker anastomosis and 66 (48.9%) Wallace anastomosis. Bricker and Wallace groups included 134 and 132 renal units, respectively. At a median follow-up of 14 (6-58) months, 21 (15.5%) patients and 30 (11.27%) renal units developed UES. We observed 22 (16.6%) affected renal units in Wallace versus 8 (5.9%) in Bricker group (p < 0.001). A bilateral stricture was most common in Wallace group (69.2%) (p < 0.001). Previous chemotherapy and 90-day Clavien-Dindo grade ≥ III complications were independently associated with stricture formation, respectively (OR 9.74, 95% CI 2-46.2, p = 0.004; OR 4.01, 95% CI 1.36-11.82, p = 0.013).
CONCLUSION: The results of this study show no significant difference in ureteroenteric anastomotic techniques with respect to UES development regarding individual patients but suggest a higher risk of bilateral UES formation in patients undergoing Wallace anastomosis. This is reflected in the increased UES rate under consideration of the individual renal units.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:407 |
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| Enthalten in: |
Langenbeck's archives of surgery - 407(2022), 3 vom: 09. Mai, Seite 1233-1240 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Krafft, U [VerfasserIn] |
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| Links: |
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| Themen: |
Bladder cancer |
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| Anmerkungen: |
Date Completed 02.06.2022 Date Revised 14.08.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00423-021-02413-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM334768233 |
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| 100 | 1 | |a Krafft, U |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparative analysis of Bricker versus Wallace ureteroenteric anastomosis and identification of predictors for postoperative ureteroenteric stricture |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Revised 14.08.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. The Author(s). | ||
| 520 | |a PURPOSE: Ureteroenteric anastomosis after cystectomy is usually performed using the Bricker or Wallace technique. Deterioration of renal function is the most common long-term complication of urinary diversion (UD). To improve surgical care and optimize long-term renal function, we compared the Bricker and Wallace anastomotic techniques and identified risk factors for ureteroenteric strictures (UES) in patients after cystectomy | ||
| 520 | |a MATERIAL AND METHODS: Retrospective, monocentric analysis of 135 patients who underwent cystectomy with urinary diversion at the University Hospital Essen between January 2015 and June 2019. Pre- and postoperative renal function, relevant comorbidities, prior chemo- or radiotherapy, pathological findings, urinary diversion, postoperative complications, and ureteroenteric strictures (UES) were analyzed | ||
| 520 | |a RESULTS: Of all 135 patients, 69 (51.1%) underwent Bricker anastomosis and 66 (48.9%) Wallace anastomosis. Bricker and Wallace groups included 134 and 132 renal units, respectively. At a median follow-up of 14 (6-58) months, 21 (15.5%) patients and 30 (11.27%) renal units developed UES. We observed 22 (16.6%) affected renal units in Wallace versus 8 (5.9%) in Bricker group (p < 0.001). A bilateral stricture was most common in Wallace group (69.2%) (p < 0.001). Previous chemotherapy and 90-day Clavien-Dindo grade ≥ III complications were independently associated with stricture formation, respectively (OR 9.74, 95% CI 2-46.2, p = 0.004; OR 4.01, 95% CI 1.36-11.82, p = 0.013) | ||
| 520 | |a CONCLUSION: The results of this study show no significant difference in ureteroenteric anastomotic techniques with respect to UES development regarding individual patients but suggest a higher risk of bilateral UES formation in patients undergoing Wallace anastomosis. This is reflected in the increased UES rate under consideration of the individual renal units | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Bladder cancer | |
| 650 | 4 | |a Bricker | |
| 650 | 4 | |a Cystectomy | |
| 650 | 4 | |a Urinary diversion | |
| 650 | 4 | |a Wallace | |
| 700 | 1 | |a Mahmoud, O |e verfasserin |4 aut | |
| 700 | 1 | |a Hess, J |e verfasserin |4 aut | |
| 700 | 1 | |a Radtke, J P |e verfasserin |4 aut | |
| 700 | 1 | |a Panic, A |e verfasserin |4 aut | |
| 700 | 1 | |a Püllen, L |e verfasserin |4 aut | |
| 700 | 1 | |a Darr, C |e verfasserin |4 aut | |
| 700 | 1 | |a Kesch, C |e verfasserin |4 aut | |
| 700 | 1 | |a Szarvas, T |e verfasserin |4 aut | |
| 700 | 1 | |a Rehme, C |e verfasserin |4 aut | |
| 700 | 1 | |a Hadaschik, B A |e verfasserin |4 aut | |
| 700 | 1 | |a Tschirdewahn, S |e verfasserin |4 aut | |
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