Comparison of modified Taguchi and Bricker ureteral reimplantation techniques after radical cystectomy.
OBJECTIVE
To present our experience with the modified Taguchi "single-stitch" ureteral reimplantation technique in patients undergoing radical cystectomy with urinary diversion compared with a traditional Bricker reimplantation technique. Improved techniques are continually sought for ureteroenteric anastomoses during urinary diversion. The modified Taguchi "single-stitch" ureteral reimplantation is reportedly a time-efficient technique that preserves anastomotic integrity.


METHODS
We retrospectively examined 75 consecutive patients with bladder cancer who underwent cystectomy and urinary diversion between October 1, 1999 and March 31, 2001. The ureteroenteric anastomosis was performed using a reinforced single-stitch modified Taguchi technique in the first 36 patients and an interrupted two-layer Bricker technique in the subsequent 39 patients during the creation of 47 orthotopic neobladders and 28 ileal conduit diversions. Ureteral stents were not routinely used. The demographic and perioperative clinical parameters were evaluated in each cohort, with particular attention to ureteral complications.


RESULTS
Modified Taguchi and Bricker ureteral anastomoses were performed in 48% and 52% of patients, respectively. Patient age, sex, and body mass indexes were similar between groups. Apart from pathologic stage, univariate analysis did not demonstrate statistically significant differences between the groups in the demographic, intraoperative (estimated blood loss, diversion type, operative time) or postoperative (length of stay, rate of complications) parameters. Ureteral complications occurred in 8% of the Bricker group and 15% of the modified Taguchi group (P = 0.23).


CONCLUSIONS
Either technique can be performed safely and in a timely fashion. However, the increased number of ureteral leaks in the modified Taguchi cohort combined with no advantage in procedure time, prompted our return to the Bricker technique exclusively.
Lee
Cheryl T
CT
Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
Chen
Bert T
BT
Gong
Edward
E
Hafez
Khaled S
KS
Sheffield
Jacqueline H
JH
Montie
James E
JE
D000714:Anastomosis, Surgical; D002278:Carcinoma in Situ / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013537:Sutures; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*