A modified ureteroileal anastomosis can reduce the incidence of ureteroileal anastomotic stricture.

Abstract

Background: Ileal conduit is widely used as a urinary diversion procedure after radical cystectomy. However, ureteroileal anastomotic stricture (UIAS) remains a threatening complication. Here we introduce a novel technique, Chen ureteroileal anastomosis, and compare its postoperative complications to Bricker anastomosis, with a specific focus on the incidence of UIAS.

Methods: A rat model was established to investigate morphological and histological alterations of the ileum in urine-stimulated environment. A double-center retrospective cohort of 124 patients undergoing laparoscopic radical cystectomy with ileal conduit between February 2017 to December 2023 was analyzed. All surgeries were performed by a regular surgical team. The demographic characteristics, clinicopathological characteristics, perioperative indicators, and postoperative complications between the two groups were recorded, assessed and compared by an independent committee.

Results: Following long-term exposure to urine, the muscular layer of the rat ileum underwent thinning and fibrosis. The two groups were comparable in all demographic and clinicopathological variables. No significant differences were observed in terms of operation time, transfusion rate, length of stay and follow-up time. Median follow-up time was 35 months (IQR, 24-42) in the Chen group and 38 months (IQR, 26-48) in the Bricker group. The rate of UIAS was significantly lower in the Chen group (1.7% vs. 13.6%, p = 0.036, 95%CI: -0.208, -0.030). Other complications were comparable.

Conclusions: In this study, we observed that Chen ureteroileal anastomosis significantly reduced the incidence of UIAS compared with Bricker ureteroileal anastomosis. No difference was observed in other postoperative complications.