Anti-Reflux Ureteroileal Anastomosis for Orthotopic Ileal Neobladder Using Wallace Technique in a Single Trough

Introduction: The aim of this study was to evaluate the modification of the subserous extramural tunnel for non-refluxing ureteroileal 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 ureteroileal 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 1 year. Results: The modified ureteroileal 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 occurred in only 2 patients (4.7%). One case of anastomotic stricture was diagnosed (2.3%), which increased to 2 cases (4.7%) after 1 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 ureteroileal 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.