A comparison of the Bricker versus Wallace ureteroileal anastomosis in patients undergoing urinary diversion for bladder cancer

Abstract

Purpose: In recent years few studies have evaluated the success and complications of the 2 most common types of ureteroenteric anastomotic techniques, the Bricker and the Wallace anastomosis. We evaluated the complications of the Bricker and Wallace techniques of ureteroenteric anastomosis in a single surgeon, single institution series.

Materials and methods: From 2001 to 2005 a total of 186 patients underwent ileal conduit or ileal neobladder after cystectomy for bladder cancer. All patients were followed for a minimum of 12 months after surgery with complete clinical information. In all cases the ureters were anastomosed to a segment of ileum in a separate (Bricker) or conjoined (Wallace) fashion.

Results: Of the 186 patients 94 underwent a Bricker (51%), 90 underwent a Wallace (48%) and 2 patients underwent both procedures (Wallace on duplicated system on 1 side, Bricker on contralateral side). Ureteral stricture developed in 5 of 186 (2.6%) patients and the overall stricture rate for all ureters was 7 of 371 (1.9%). In patients undergoing Bricker anastomosis the total stricture rate for all ureters was 3.7% (7 of 187). With the Wallace anastomosis the total stricture rate for all ureters was 0% (0 of 184). This difference in stricture rate in the Bricker vs Wallace subgroups was significant (p = 0.015). There was no difference in age, gender, creatinine, prior radiation, complications or mode of diversion between the groups. Body mass index was higher in the Bricker vs the Wallace group (29.0 vs 25.9 kg/m(2)). Of the 5 patients with strictures 1 underwent successful open repair, 1 had successful interventional radiological repair and 3 were treated with chronic ureteral stents (1 after failed open repair and 2 after failed radiological repair).

Conclusions: Both the Bricker and the Wallace anastomoses provide acceptably low stricture rates in a single surgeon case series. Indeed, the Wallace anastomosis had no strictures in this series. The Bricker group had a higher body mass index which was likely due to the often disparate ureteral lengths in obese patients after retrosigmoidal tunneling, which would have affected the choice of technique.