Retrosigmoid ileal conduit versus traditional techniques after radical cystectomy: Impact on the incidence of ureteroileal anastomotic stricture.

INTRODUCTION AND

OBJECTIVE

Ureteroileal anastomotic stricture (UAS) is a relevant complication after radical cystectomy (RC). The retrosigmoid ileal conduit (RIC) may reduce its incidence by avoiding left ureteral transposition.

OBJECTIVE

To compare the incidence of UAS, perioperative outcomes, and length of stay between RIC and conventional urinary diversions (Bricker/Wallace).

MATERIAL AND

METHODS

Retrospective, single-center observational study. All patients undergoing RC with bilateral urinary diversion were included: RIC between 01/2021-12/2024 and conventional techniques between 01/2018-12/2020. Primary variable: Multivariable logistic regression was performed using: age, body mass index (BMI), prior urinary tract dilation, Charlson Comorbidity Index (CCI), Eastern Cooperative Oncology Group (ECOG) score, and surgical technique. Secondary variables: operative time, 30-day postoperative complications (grouped as minor complications [Clavien 1-2] and major complications [Clavien ≥3]), time to stricture, length of hospital stay, and follow-up time after surgery.

RESULTS

Seventy-one patients were analyzed: 36 RIC and 35 controls, with comparable baseline characteristics. UAS presented an incidence of 2.8% in RIC group and 22.9% in controls; the RIC technique was associated with a lower adjusted risk (OR: 0.05; 95% CI: 0.002-0.35; P = .011). Operative time was shorter with RIC (median: 292 [IQR: 274-315] vs. 330 [308-360] min; p = 0.00025). There were no differences in major complications (11.1 vs. 17.1%; P = .51) or minor complications (33.3 vs. 42.9%; P = .41), nor in hospital stay (11.5 vs. 9 days; P = .23). The median follow-up was 18 months (RIC) and 39 months (control).

CONCLUSIONS

In our series, RIC significantly reduced UAS without increasing morbidity and was associated with a shorter operative time compared with traditional techniques. The results support the anatomical consistency and reproducibility of the technique.