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Updated: Jan 17, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Does ureteroileal anastomosis technique (Bricker versus Wallace) influence benign ureteroileal stricture occurrence
A Fortier1, S Mokadem2, A Saadi2
1Urology Department, University Hospital Centre Rouen, Rouen, France.
Purpose:
The primary aim of our study was to compare the incidence of benign ureteroileal stricture (BUIS) regarding surgical technique.
Methods:
We retrospectively included 241 patients undergoing radical cystectomy for bladder cancer with an ileal conduit, performed between January 2015 and December 2021, in three centers (1 in Tunisia, 2 in France) excluding patients with tumor recurrence. Anastomotic stricture was defined as ureterohydronephrosis upstream from the UIA on any CT scan, and with either symptomatic obstruction, obstruction on functional imaging, or late renal atrophy.
Results:
We included 124 patients in the Tunis center (98% Bricker) and 117 patients in the Rouen and Elbeuf centers (95% Wallace) with median follow-up of 2 years. There were significant differences in demographics between the groups, including age, BMI, anticoagulants, abdominopelvic surgery or radiotherapy. The overall risk of BUIS at 36 months was 20.1% (95% CI: 14.4 to 25.5%). Although unadjusted analyses found a trend towards lower incidence of BUIS in the Tunis (Bricker) center compared to Rouen and Elbeuf (Wallace), it disappeared after adjustment on confounders (hazard ratio Tunis vs. Rouen and Elbeuf=0.98, 95% CI: 0.46 to 2.11, P=0.97, primary analysis). The unadjusted hazard ratio of separated stitches on the risk of BUIS was estimated at 0.32 (0.13 to 0.81, P=0.02) in the subgroup of patients treated in Tunis, where the type of suture data was not missing.
Conclusion:
Our study does not provide any guidance to choose the technique. Interestingly, separated stitches were associated with a significantly lower rate of BUIS.
