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. 2025 Jul 15;25(1):173.
doi: 10.1186/s12894-025-01869-6.

Posterior conduit fixation with retroperitonealization of uretero-ileal anastomosis after open radical cystectomy reduces the postoperative complication rate: a retrospective, matched-paired single-center analysis

Vukovic Marko  1 , Kavaric Petar  2 , Magdelinic Aleksandar  2 , Albijanic Marko  2 , Rebronja Almir  2 , Sabovic Eldin  2
Affiliations

Posterior conduit fixation with retroperitonealization of uretero-ileal anastomosis after open radical cystectomy reduces the postoperative complication rate: a retrospective, matched-paired single-center analysis

Vukovic Marko et al. BMC Urol. .

Abstract

Background: Our study aimed to assess the efficacy of posterior conduit fixation with retroperitoneal ureteroileal anastomosis (UIA) in reducing perioperative complications after radical cystectomy (RC) with ileal conduit (IC) urinary diversion.

Methods: We conducted a retrospective case-control study, including 150 patients who underwent either modified IC technique (extraperitonealized anastomosis with posterior conduit fixation; n = 79) or the conventional IC technique (n = 71). The primary endpoints were the incidence of clinical parastomal hernia (PSH) and ileus. Secondary endpoints included operative time, postoperative complication rates, and length of hospital stay (LOS). Multivariate logistic regression was performed to identify predictors of early and late stoma- related complications.

Results: The modified group showed significantly lower incidence of both early and late postoperative complications, including ileus and PSH, compared to the conventional group (8.86% vs. 28.1%, p = 0.01 and 7.6% vs. 17%, p = 0.03, respectively) after a median follow-up of 34 months. Corresponding hazard ratios were 0.312 (95% CI: 0.047-0.798, p = 0.01) for early complications and 0.267 (95% CI: 0.105-0.611, p = 0.03) for late complications.

Conclusion: The results support our hypothesis that extraperitoneal ureteroileal anastomosis combined with posterior conduit fixation effectively reduces the risk of both early and late postoperative complications, including parastomal hernia and ileus.

Keywords: Cystectomy; Postoperative complication; Urinary diversion.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was reviewed and approved by a certified ethical board of the Clinical Center of Montenegro (Nr 03/01-517-1). Verbal informed consent was obtained and documented in the medical records. Consent for publication: No written consent was required by the ethical board. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Description of the modified technique of ileal conduit urinary diversion: A extraperitonealization of ureteroileal anastomosis: 1 -peritoneal flap covering the anastomosis; 2 - reconstructed peritoneum; 3 - ileal conduit segment; 4 - small bowel loop; B final shape of the ileal conduit: (a) parietal peritoneum covering the ureteroileal anastomosis and small part of the proximal conduit; (b) free conduit segment fixed for the peritoneum covering the posterior abdominal wall; (c) fixation points using 3–0 Vycryl sutures; C distal end of the conduit anchored to the anterior rectus sheath with two interrupted Vicryl 3–0 sutures and then to the skin-forming stoma nipple: thin arrow– two anchor sutures to the anterior rectus sheet; dicking arrow– stoma nipple fixed to the skin
Fig. 2
Fig. 2
Intraoperative view of the modified technique: A 1 - peritoneum; 2 - ureteral plate; 3 -conduit segment; B a-peritoneal flap extraperitonealizing the ileal conduit and the anastomotic site; b - conduit segment; c - fixation point for the periosteum covering the posterior abdominal wall; d - reconstructed peritoneal cavity
Fig. 3
Fig. 3
Kaplan‒Meier diagram showing complication-free survival between the two groups
See this image and copyright information in PMC

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