Dipping Technique for Ureteroileal Anastomosis in Orthotopic Ileal Neobladder: 20-Year Experience in 670 Patients—No Stenosis with Preservation of the Upper Tract

Objectives. Many techniques were described for ureteroileal anastomosis in orthotopic bladder substitution, ranging from nonrefluxing to refluxing techniques, all aiming at preservation of the upper tract. We describe our technique of dipping the ureter into the ileal pouch, which is simple and had no complications. Patients and Methods. Our technique implies dipping the ureter in the lateral side of the pouch, in right and left corners, with two rows of four sutures fixing the seromuscular layer of the ureter to the seromuscular layer of the ileal pouch. The procedure was applied in both normal ureteric calibre and dilated ureter. Total number of procedures done was 1,340 ureters in 670 patients after radical cystectomy for invasive carcinoma of the bladder of urothelial and nonurothelial cancer. Results. Followup of patients every six months and onward did not show stenosis in the ureteroileal anastomotic site. Filling of the ureter with contrast dye on ascending pouchogram was observed in patients who had considerably dilated ureters at the time of cystectomy. Normal ureter did not show clinical reflux but radiological filling of the ureter when the intravesical pressure exceeded the leak point pressure. Time to perform the dipping technique was 5–7 minutes for each site. Conclusion. Dipping technique for ureteroileal anastomosis in orthotopic ileal neobladder avoids the incidence of stenosis, preserves the upper tract, is a fast procedure, stands the evaluation in long-term followup, and was practiced successfully for twenty years. 1. Introduction Since the introduction of orthotopic ileal neobladder in 1985, the procedure gained wide acceptance and has been practiced by most urologist. The turning point in the technique of orthotopic ileal neobladder was the introduction of the detubularised ileal pouch that ensured low pressure reservoir protecting the upper tract from high-pressure reflux. Many techniques addressed the antireflux procedures in the ureteroileal anastomosis (UIA), which were first described by Le duc et al. [1], simultaneously Koch described the antireflux intussuscepted nipple that was widely applied [2]; Studer et al. introduced the technique of UIA to an afferent tubular isoperistaltic segment [3, 4]; Abol-Enein et al. introduced the procedure of serous-lined extramural tunnel which was described for normal and dilated ureter [5, 6]. The era of antireflux UIA was followed by the introduction of the concept reflux or nonreflux ureteric anastomosis [7, 8]. There were and still are arguments on performing which technique. Stenosis