Urinary complications following Bricker urinary diversion in gynecologic cancer: A retrospective analysis of 77 cases
Eya Jaafar, Houssein El Hajj, Amandine Maulard, Pierre André Mal, Stéphanie Scherier, Thomas Dabreteau, Kim Do, François Zaccarini, Bastien Parier, Sophie Espenel, Alexandra Leary, Patricia Pautier, Catherine Genestie, Philippe Morice, Sébastien GouyAbstract
Introduction
To evaluate postoperative urinary complications and their management in patients undergoing Bricker urinary diversion for gynecologic cancers, with a focus on identifying risk factors, especially uretero‐ileal strictures.
Material and Methods
We conducted a retrospective single‐center study of 77 patients who underwent Bricker urinary diversion for gynecologic cancers between 2000 and 2020. All surgeries were performed by the same gynecologic oncologic team.
Results
Primary tumor sites included the cervix and uterine body in 87% of patients, with others involving the vagina, vulva, and adnexa. Preoperative pelvic radiotherapy was performed in 71%, and para‐aortic/pelvic radiotherapy in 10%. Over a median follow‐up of 21 months, uretero‐ileal strictures occurred in 30%, and fistulas in 6%. Preoperative nephrostomy was significantly associated with a higher rate of strictures ( p = 0.001), while preoperative ureteral stenting was associated with a reduced risk ( p = 0.005). All patients with strictures or fistulas were initially managed with ureteral stenting; nephrostomy was subsequently required in 56% of stricture and 80% of fistula cases. Surgical treatment was eventually needed in 17% and 60%, respectively. Additional risk factors for strictures included preoperative chemotherapy ( p = 0.023) and intraoperative evidence of chronic enteritis ( p = 0.013). No significant differences were observed in overall or recurrence‐free survival between patients with and without strictures ( p > 0.05).
Conclusions
Uretero‐ileal strictures occurred in 30% and fistulas in 6% of patients undergoing Bricker urinary diversion. Preoperative ureteral stenting may help reduce stricture risk, and appropriate bowel segment selection is essential to minimize complications.