Urologia internationalis · 2026
Clinical Application and Outcomes of a Modified Nipple Technique for Uretero-Ileal Conduit Anastomosis during Ileal Conduit Diversion.
СтатьяНазвание и аннотация: Перевод в очереди
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Yang Zhanpo, Li Zhichun, Gao Yue, Xing Wenzhou, Dou Xinmeng, Zhou Wenhui, Liu Qian, Ma Hongshun
Аннотация
INTRODUCTION: Anastomotic stricture following uretero-ileal conduit (IC) anastomosis remains a difficult clinical dilemma after radical cystectomy (RC), predisposing to upper urinary tract obstruction and renal impairment. We aimed to describe an altered nipple technique for uretero-IC anastomosis and determine its safety, efficacy, and anti-reflux effect compared with conventional techniques.
METHODS: This was a single-institution retrospective series of 32 sequential patients with bladder cancer undergoing RC and IC urinary diversion with the modified nipple technique (July 2013-October 2023). All cases were performed in a tertiary academic center with adequate follow-up. RC was followed by creation of IC. The nipple valve technique was adapted, employing a trapezoidal incision and invagination to form a "nipple" anti-reflux structure at the anastomosis, to reduce stricture and maximize urine flow. Outcomes were incidence of uretero-ileal anastomotic stricture (UES), Clavien-Dindo graded perioperative complications, operating time, recovery parameters, and renal function followed up clinically and radiologically.
RESULTS: Of 32 patients (31 male, 1 female), 17 underwent open RC, 14 underwent laparoscopic RC, and 1 underwent conversion to open RC. The mean follow-up was 70 ± 36 months (range: 12-110 months). Only 1 patient (3.1%) developed anastomotic stricture, successfully treated endoscopically, with no progression of hydronephrosis or clinically apparent deterioration of renal function. The overall 90-day rate of complications was 34.3%. Limitations include the retrospective single-center design, relatively small sample size, predominance of male patients, lack of standardized renal function assessment, and absence of predefined oncological outcome analyses. Therefore, the observed low incidence of UES should be interpreted with caution.
CONCLUSIONS: The modified nipple technique appears to be a feasible and reproducible reconstructive option for uretero-ileal anastomosis during IC diversion. The favorable outcomes observed in this cohort warrant further validation in larger prospective multicenter studies.
METHODS: This was a single-institution retrospective series of 32 sequential patients with bladder cancer undergoing RC and IC urinary diversion with the modified nipple technique (July 2013-October 2023). All cases were performed in a tertiary academic center with adequate follow-up. RC was followed by creation of IC. The nipple valve technique was adapted, employing a trapezoidal incision and invagination to form a "nipple" anti-reflux structure at the anastomosis, to reduce stricture and maximize urine flow. Outcomes were incidence of uretero-ileal anastomotic stricture (UES), Clavien-Dindo graded perioperative complications, operating time, recovery parameters, and renal function followed up clinically and radiologically.
RESULTS: Of 32 patients (31 male, 1 female), 17 underwent open RC, 14 underwent laparoscopic RC, and 1 underwent conversion to open RC. The mean follow-up was 70 ± 36 months (range: 12-110 months). Only 1 patient (3.1%) developed anastomotic stricture, successfully treated endoscopically, with no progression of hydronephrosis or clinically apparent deterioration of renal function. The overall 90-day rate of complications was 34.3%. Limitations include the retrospective single-center design, relatively small sample size, predominance of male patients, lack of standardized renal function assessment, and absence of predefined oncological outcome analyses. Therefore, the observed low incidence of UES should be interpreted with caution.
CONCLUSIONS: The modified nipple technique appears to be a feasible and reproducible reconstructive option for uretero-ileal anastomosis during IC diversion. The favorable outcomes observed in this cohort warrant further validation in larger prospective multicenter studies.