Abstract
The main aim of every urinary diversion is to preserve the morphological and functional integrity of the upper urinary tracts. Stenosis of the uretero-intestinal anastomosis is one of the most dreaded complications. This alone may jeopardise the success of the operation and the quality of life that remains for the patient.
Material and methods
From November ‘94 to December ‘97,109 patients (average age 68 years, range 48–79) underwent radical cystectomy with urinary diversion (53 VIP, 42 Bricker, 4 Reddy2, 3 USS, 2 Studer, 1 Mainz1, 1 Mainz2, 2 Indiana, 1 Camey2). 216 anti-reflux u-i anastomoses were created (93 Le Duc, 6 Leadbetter, 4 Goodwin, 2 Split-cuff, 2 Mainz, 2 Ghoneim) and 107 direct anastomoses (41 Nesbit, 35 Wallace1, 13 Bricker, 12 Polsino, 6 Wallace2).
Results
18/216 (8.3%) stenoses occurred (none secondary to neoplastic recurrence): 11/109 (10%) in u-i anastomoses made with the anti-reflux technique (6 Le Duc, 2 Ghoneim, 2 Mainz, 1 Leadbetter) and 7/107 (6.5%) with direct implantation (3 Nesbit, 2 Polsino, 2 Wallace1). Stenoses occurred in 9 VAP, 3 Bricker, 2 Reddy2 (bilateral in 4 patients).
Conclusions
The high number of variants of uretero-intestinal anastomosis techniques demonstrates that there is as yet no commonly accepted technique, every surgeon performing the procedure that in his experience produces the best results with the fewest complications. The choice of type of anastomosis should take into account the type of urinary diversion with its urodynamic characteristics, searching as far as possible to create anti-reflux mechanisms in the orthotopic diversions. The common principles of surgical technique remain valid, i.e. to respect the anatomical structure, to avoid stretching or curving of the ureter, to create leak-proof anastomoses.
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