URETERAL ANASTOMOSIS IN THE ORTHOTOPIC ILEAL NEOBLADDER - COMPARISON OF 2 TECHNIQUES

Purpose: The functional results and complications of 2 different urete roileal anastomoses were evaluated in patients with bladder cancer und ergoing radical cystectomy and orthotopic ileal bladder substitution. Materials and Methods: Between 1989 and 1995, 102 patients underwent c reation of a low pressure neobladder. In the first 50 cases the ureter oileal anastomosis was created with a split-cuff nipple technique as a n additional antireflux mechanism. In the next 52 cases the ureteroile al anastomoses were constructed via the direct end-to-side technique c ounting on the antireflux protection of the afferent tubular limb. Res ults: Stenosis occurred in 7 of the 100 ureters (6 patients) treated w ith the split-cuff nipple technique and 7 of 104 treated with a direct end-to-side anastomosis. This complication occurred more commonly in the left ureter (11 of 14 patients). Reflux was noted at cystography i n 10 cases with the split-cuff nipple method and 12 with end-to-side a nastomoses, and was symptomatic in only 3 patients. Four ureteral stri ctures were treated successfully with primary open repair. Percutaneou s dilation and stenting were performed for 8 ureteral strictures: 2 ca ses were successful, 3 failed and 3 are unresolved. Conclusions: We ob served no differences between the antireflux split-cuff and end-to-sid e anastomoses with regard to stricture formation or ureteral reflux. T herefore, we do not believe that there is a need to create antireflux ureteral anastomoses due to the tubular afferent ileal segment and giv en that the reflux is asymptomatic in most patients. Strictures may be treated with percutaneous balloon dilation and stenting but open repa ir appeared to be more effective.