Wallace direct versus anti‐reflux Le Duc ureteroileal anastomosis: Comparative analysis in modified Studer orthotopic neobladder reconstruction

Abstract

Objectives: To investigate and compare Wallace direct ureteroileal anastomosis with Le Duc anti-reflux procedure in modified Studer orthotopic neobladder reconstruction after radical cystectomy. Methods: A total of 72 consecutive patients who underwent modified Studer orthotopic bladder reconstruction after a radical cystectomy for bladder cancer were investigated. They were examined for vesicoureteral reflux, hydronephrosis, and pyelonephritis at 6 months after surgery according to the type of ureteroileal anastomosis. Results: Vesicoureteral reflux occurred in 29 ureters (38.2%) after the Wallace procedure compared to six ureters (9.6%) with the Le Duc (P < 0.05). Hydronephrosis was detected in 12 ureters (18.8%) in the Le Duc patients compared to seven (9%) in the Wallace patients (P > 0.05). Six months after the operation, all three patients with vesicoureteral reflux-related hydronephrosis improved using clean intermittent catheterization in the Le Duc patients; five of seven patients were cured by clean intermittent catheterization and two improved without any treatment in the Wallace patients. Seven of nine cases of ureteroileal anastomosis stenosis causing hydronephrosis were cured without any treatment but one case resulted in a non-functional kidney despite treatment of the stenosis. Conclusions: Direct ureteroileal anastomosis using the Wallace method is effective for minimizing ureteroileal anastomosis stenosis and it represents a simple surgical procedure when combined with a modified Studer procedure.

Urinary Diversion in the Elderly

“…The group noted an expected significantly higher vesicoureteral reflux rate in the Wallace group 38.2 % compared to 9.6 % in the LeDuc group, however, with no significant increase in creatinine at 6 months. The anastomotic stricture rate causing hydronephrosis was 75 % (9 out of 12 patients with hydronephrosis) in the LeDuc group vs. 0 % in the Wallace group with a p value of 0.007 [34].…”

“…Although limited analytical literature on Le Duc anastomotic technique exists, the stricture rate has consistently been reported as significantly higher [34,35]. Shigemura et al in 2012 evaluated 712 patients in which 32 had LeDuc and 39 had Wallace ureteral anastomosis who underwent a modified (N-shaped) Studer neobladder urinary diversion with a median follow-up of 29.5 months.…”

Novel augmentation ileocystoplasty technique to manage non‐compliant bladders in the presence of obstructed megaureters: The “fez procedure”

“…Additionally, antirefluxing techniques did not guarantee the non‐existence of reflux, particularly with preoperatively dilated ureters . Similarly, Shigemura compared the direct ureteroileal anastomosis using the Wallace method versus Le Duc ureteroileal anastomosis in modified Studer's orthotopic neobladder reconstruction, and they concluded that direct ureteroileal anastomosis was a simple technique minimizing the incidence of anastomotic stenosis . Furthermore, Waidelich et al reported on 15 patients with direct ureteroileal anastomosis using Studer's technique, and confirmed the postoperative absence of vesicoureteral reflux …”

“…6 Nevertheless, different procedures were described to implant the ureters into bowel segments used for orthotopic neobladders; including both antireflux and direct anastomosis procedures. 7,[13][14][15] The benefits of antireflux techniques have been overestimated despite the higher rates of stricture formation; and direct ureteroileal anastomosis seems to be more rational than antireflux techniques for non dilated ureters. Hassan et al compared the outcomes of the Le Duc antireflux technique versus direct anastomosis for ureteral implantation in the setting of orthotopic Y-ileal neobladder.…”

A preliminary oncologic outcome and postoperative complications in patients undergoing robot-assisted radical cystectomy: Initial experience

“…Orthotopic neobladders were created using the Studer method. Ureteroileal anastomoses of the ileal conduit or neobladder were constructed with Wallace ureteroileal anastomoses [11]. In 4 cases, we performed intracorporeal ileal conduit urinary diversion.…”