[Ureterointestinal anastomosis in urinary diversion - current opinion]

Area of Science:

• Urology
• Surgical Techniques
• Oncology

Background:

• Uretero-intestinal anastomosis (UIA) is crucial in urinary diversion, with complications impacting patient outcomes.
• Techniques aim to minimize early and late post-surgical issues.
• The use of antireflux UIA in orthotopic neobladders is debated due to potential obstruction risks.

Purpose of the Study:

• To evaluate the efficacy and complication rates of different uretero-intestinal anastomosis techniques.
• To provide guidance on the selection of antireflux versus refluxing UIA based on urinary diversion type.

Main Methods:

• Review of current surgical techniques for uretero-intestinal anastomosis.
• Analysis of complication rates associated with refluxing and antirefluxing UIA.
• Consideration of expert recommendations and guidelines (e.g., ICUD-EAU).

Main Results:

• Simple refluxing end-to-side UIA is associated with low complication rates in low-pressure orthotopic reservoirs.
• Antireflux UIA may increase obstruction risk, potentially endangering renal function more than reflux.
• The flap-and-trough (FT) technique offers a nonrefluxing UIA with a low risk of stenosis.

Conclusions:

• A simple refluxing UIA is the preferred method for low-pressure orthotopic reservoirs.
• Reflux prevention is well-justified for ileal conduits, continent cutaneous diversions, and anal diversions.
• The choice of UIA technique should be tailored to the specific urinary diversion and patient risk factors.