PURPOSE: The ileal conduit of Bricker is still widely used for urinary diversion after radical cystectomy for bladder carcinoma. We have modified the standard technique with the aim of reducing the complication rate and facilitating treatment. MATERIALS AND METHODS: We leave the conduit in its natural isoperistaltic anterior position, the ureters are anastomosed in an anterior position on their own side, using a short ileum segment. The incision of the peritoneum is made in a particular manner to allow on its closure to extraperitonealize the anastomoses and the bottom of the conduit and to support and fasten the loop. RESULTS: A total of 100 consecutive patients after radical cystectomy for bladder cancer had anterior ileal conduit. The complication rates were 5% temporary ureteroileal leakage, 1% reoperation rate, 5% long-term stenoses and 3% renal function deterioration. The surgical revision and the treatment of ureteroileal stenoses with anterograde percutaneous ureteral stenting were not complicated procedures. A comparison with conventional Bricker series shows a significant decrease in the complication rate. CONCLUSIONS: The anterior ileal conduit reduces the technique complication rate and facilitates the treatment of complications, and it is a recommended operation for these reasons.
PURPOSE: The ileal conduit of Bricker is still widely used for urinary diversion after radical cystectomy for bladder carcinoma. We have modified the standard technique with the aim of reducing the complication rate and facilitating treatment. MATERIALS AND METHODS: We leave the conduit in its natural isoperistaltic anterior position, the ureters are anastomosed in an anterior position on their own side, using a short ileum segment. The incision of the peritoneum is made in a particular manner to allow on its closure to extraperitonealize the anastomoses and the bottom of the conduit and to support and fasten the loop. RESULTS: A total of 100 consecutive patients after radical cystectomy for bladder cancer had anterior ileal conduit. The complication rates were 5% temporary ureteroileal leakage, 1% reoperation rate, 5% long-term stenoses and 3% renal function deterioration. The surgical revision and the treatment of ureteroileal stenoses with anterograde percutaneous ureteral stenting were not complicated procedures. A comparison with conventional Bricker series shows a significant decrease in the complication rate. CONCLUSIONS: The anterior ileal conduit reduces the technique complication rate and facilitates the treatment of complications, and it is a recommended operation for these reasons.
Authors: Jeffrey J Leow; Jens Bedke; Karim Chamie; Justin W Collins; Siamak Daneshmand; Petros Grivas; Axel Heidenreich; Edward M Messing; Trevor J Royce; Alexander I Sankin; Mark P Schoenberg; William U Shipley; Arnauld Villers; Jason A Efstathiou; Joaquim Bellmunt; Arnulf Stenzl Journal: World J Urol Date: 2019-01-25 Impact factor: 4.226