Anti-reflux uretero-ileal anastomosis for orthotopic ileal neobladder using Wallace technique in a single trough.

Introduction: To evaluate the modification of the subserous extramural tunnel for non-refluxing uretero-ileal anastomosis in U - shaped pouches using the Wallace technique with a single trough.

Methods: This prospective study was conducted from 2017 to 2022 in a single tertiary center after approval from the research ethics committee of our institution (approval number: FWA 000017585). 45 patients' candidates for radical cystectomy and orthotopic urinary diversion were included in this study. The patients were diverted using a U-shaped pouch with uretero-ileal anastomosis, combining the extramural serous-lined tunnel and Wallace techniques in a single trough. Operative time and complications, including ureteric obstruction, reflux, and renal function, were recorded within one year.

Results: The modified uretero-ileal anastomosis combined with the extramural serous-lined tunnel and Wallace techniques had a relatively short operative time (mean 132.2 ± 18.3 min) and short bowel segment incorporation (30 cm). In 43 patients, vesicoureteral reflux (VUR) occurred in only two patients (4.7%). One case of anastomotic stricture was diagnosed (2.3%), which increased to two cases (4.7%) after one year. Three patients (7%) developed pyelonephritis during the year. The mean serum creatinine level of the patients before the operation was 1.2 mg/dl, which increased to 1.4 mg /dl 6 months postoperatively.

Conclusion: A modification of the subserous extramural tunnel for non-refluxing uretero-ileal anastomosis in U-shaped pouch appears to be a good simple alternative that is less time consuming and using a shorter segment of bowel for orthotopic diversion with a comparable complication rate.