LONG-TERM FOLLOW-UP RESULTS OF OUR 10-YEAR ILEAL LOOP SERIES AND COMPARISON OF URETEROILEAL ANASTOMOSIS TECHNIQUES (BRICKER AND WALLACE)

Abstract

Abstract

Introduction: Bladder cancer is the second most frequent cancer of the genitourinary system. Radical

cystectomy maintains its position as the gold standard in the treatment of local invasive bladder cancer. The

ileal loop introduced by Seiffert and popularized by Bricker has been used for half a century, and it is still

considered a standard form of urinary diversion following cystectomy for bladder cancer. The purpose of this

study was to evaluate the long-term follow-up results of patients in whom radical cystectomy and ileal loop had

been performed within the last 10 years in our clinic because of local invasive bladder tumors, and to compare

two anastomosis techniques used in ureteroileal anastomoses.

Materials and Methods: Follow-up data of 74 patients in whom radical cystectomy and ileal loop had been

performed in our clinic between 1994 and 2004 were retrospectively examined. Complications seen within the

postoperative 30 days were recorded as early complications, and complications seen in later periods were

recorded as late complications. Early and late postoperative complication rates for the entire patient groups

were determined. Group 1 included 60 patients in whom Bricker technique had been applied as the

ureteroileal anastomosis technique and Group 2 included 14 patients in whom Wallace technique had been

applied. These two groups were compared in terms of age, mean follow-up period, pathological stages, and

ureteral complications as stricture and leakage in anastomosis.

Results: The mean age of patients was 60.7±9.68 years (28-80), and average follow-up period was

17.6±19.11 months (1-96). Pathologically, 70 of the patients (94.6%) had transitional-cell cancer, 3 (4%) had

adenocancer, and 1 (1.4%) had squamous-cell cancer. In six patients out of 74 (8.8%) prostate adenocancer

was determined incidentally. During follow-up 14 of the patients were lost. While early complications were

seen in 17.5% of the patients, the most frequent early complication was evisceration (12.2%). Late

complications were seen in 32.4% of the patients. The most frequent complications in late period were

hydronephrosis and ureteral anastomosis stricture (10.8%). Two groups with Bricker and Wallace type

ureteroileal anastomosis were similar in terms of age, gender, and the distribution of pathological stages.

Anastomosis stricture was seen in 8 patients and urine leakage from the anastomosis in 2 out of 60 patients in

the Bricker technique group. Anastomosis stricture and urine leakage were observed in none of the patients in

Group 2.

Conclusion: Wallace technique can be preferred as the ureteroileal anastomosis method in ileal loop

diversion after radical cystectomy, since it has lower complication rates when compared to Bricker technique.