Department of Urology, University Hospital Essen, Essen, Germany.
Department of Urology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
Int J Urol. 2024 Jul;31(7):813-818. doi: 10.1111/iju.15471. Epub 2024 Apr 21.
The aim of our study is to evaluate the difference in stricture rate between matched groups of Bricker and Wallace techniques for ureteroileal anastomosis.
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.
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.
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.
本研究旨在评估 Bricker 技术与 Wallace 技术行输尿管-回肠吻合术的吻合口狭窄率差异。
回顾性分析在两所大学医院接受 Bricker 和 Wallace 输尿管-回肠吻合术的尿流改道术患者。根据年龄、性别、体重指数（BMI）、Charlson 合并症指数（CCI）、术前肾积水、既往放疗或腹部手术、病理 T 分期和 N 分期以及 30 天 Clavien 分级并发症≥III 级，将两组 Bricker 和 Wallace 患者以 1:1 比例进行匹配。对所有患者进行多变量 Cox 回归分析，以确定输尿管-肠吻合口狭窄（UES）的预测因素。
共有 740 例患者符合纳入标准，每组 209 例患者进行倾向匹配。中位随访 25 个月时，Bricker 组和 Wallace 组分别有 25（12%）和 30（14.4%）例患者发生 UES（p=0.56）。然而，Bricker 组只有 1 例患者发生双侧狭窄，而 Wallace 组有 15 例患者发生双侧狭窄，导致 Wallace 组受影响的肾脏单位数量明显更多：45（10.7%）对 Bricker 组的 26（6.2%）（p=0.00）。多变量扩展 Cox 分析显示，既往放疗、盆腔 T4 期恶性肿瘤和淋巴结阳性疾病是 UES 形成的独立预测因素。
输尿管-回肠吻合术本身并不会增加狭窄的发生率；然而，将两个肾脏单位转化为一个会导致双侧上尿路受累的发生率更高。
