# Comparative analysis of ureteroileal anastomotic stricture rates: Bricker versus Wallace techniques in ileal conduit urinary diversion—a single-surgeon study with BMI-matched design and long-term follow-up excluding cancer recurrence bias

## TL;DR

This study compares two surgical techniques for urinary diversion and finds no significant difference in stricture rates, but one method is faster and requires shorter hospital stays.

## Contribution

A single-surgeon, BMI-matched study comparing Bricker and Wallace techniques with long-term follow-up to avoid cancer recurrence bias.

## Key findings

- No significant difference in hydronephrosis incidence between Bricker and Wallace techniques.
- Bricker technique had longer operative time and hospitalization duration compared to Wallace.
- All strictures observed were asymptomatic (Onen Grade 1).

## Abstract

Ureteroileal anastomotic stricture (UIAS) remains a critical complication following ileal conduit urinary diversion for muscle-invasive bladder cancer (MIBC). Despite widespread use of Bricker and Wallace techniques, comparative outcomes remain debated. This study compares stricture rates between these techniques under standardized surgical conditions, controlling for body habitus and without cancer recurrence-related stenosis.

A retrospective analysis included 46 patients undergoing laparoscopic ileal conduit diversion by a single surgeon (2017–2021). Patients were stratified into Bricker (n=18) and Wallace (n=28) groups, matched for BMI and comorbidities. Hydronephrosis severity was graded using the Onen system. Statistical analyses utilized Fisher’s exact test, Mann-Whitney U test, and t-test.

No significant difference in hydronephrosis incidence was observed (Bricker: 11.1% vs. Wallace: 0%, p=0.148). However, the Bricker group exhibited longer operative time (301.89 ± 11.76 vs. 281.32 ± 10.15 minutes, p<0.001) and hospitalization duration (18.18 ± 8.22 vs. 11.38 ± 5.11 days, p=0.005). All strictures were asymptomatic (Onen Grade 1).

Both techniques demonstrate comparable safety regarding stricture rates. Wallace anastomosis offers superior operative efficiency, while Bricker requires additional time for technical precision. This study highlights the importance of standardized surgical protocols and long-term surveillance in optimizing urinary diversion outcomes.