Direct versus nonrefluxing ureteroileal anastomosis in ileal neobladder

ABSTRACT

Does the theoretical benefit of reflux prevention in low-pressure bladder substitutions outweigh the potentially high rate of anastomotic stricture? Over 6 years, 120 renal units in 60 patients were reimplanted in orthotopic ileal neobladder following radical cystectomy. They were classified into 3 groups 60 renal units were reimplanted by direct end to side technique, 30 units by extramural serous lined technique and 30units by Le Duc technique. Pre and postoperative bacteriologic study, blood chemistry, IVU, renal isotope scanning and postoperative micturating pouchogram were done in all cases after 3, 6months and then annually for 6-60months [mean, 36months].The following data were recorded in the 3 groups respectively Rate of anastomotic stricture; 1.66%, 13.33% and 26.66%. Reflux; 15%, 3.33% and 6.66%.Upper tract dilation; 11.66%, 13.33% and 30%.Significant decrease in GFR; 11.66%, 13.33% and 30%.Azotemia; 3.33%, 6.66% and 13.33%. Asymptomatic bacteriurea; 26.66%, 20% and 20%.Pyelonephritis; 6.66%, 6.66% and 10%.Upper tract stone formation; 1.66%, zero and 3.33%. Nonrefluxing methods of ureteroileal anastomosis resulted in statistically significant higher rate of anastomotic stricture and upper tract dilation than direct end to side anastomosis. This is a high cost for any theoretical benefits of preventing pyelonephritis, azotemia or stone formation. In low-pressure bladder substitutions, direct ureteroileal anastomosis may be the technique of choice as it preserves kidney function and morphology, simple and time saving technique