Uretero-Ileal Anastomotic Strictures Following Bricker Urinary Diversion: A Retrospective Study

Abstract

Aims: This study evaluated the incidence, clinical presentation, management strategies, and risk factors associated with uretero-ileal anastomotic strictures (UIAS) after radical cystectomy with Bricker ileal conduit urinary diversion and compared the findings with published data. Study Design: Retrospective single-centre observational study. Place and Duration of Study: Department of Urology, Mohammed VI University Hospital, Tangier, Morocco, January 2021 to January 2026. Methodology: Medical records of patients who underwent radical cystectomy with Bricker ileal conduit diversion were reviewed retrospectively. Patients operated on at the study institution were included; those with incomplete records, insufficient postoperative follow-up, loss to follow-up, or surgery performed elsewhere were excluded. Demographic, clinical, perioperative, and postoperative variables were analysed. Results: Among 88 patients, 10 developed UIAS, corresponding to an incidence of approximately 12%. The mean age of affected patients was 62 years, and 80% were male. No statistically significant association was identified between stricture occurrence and age, sex, or smoking status. Strictures were detected incidentally on surveillance imaging in 50% of cases, while deterioration of renal function, acute pyelonephritis, and flank pain accounted for 30%, 10%, and 10% of presentations, respectively. The mean time to diagnosis was approximately 12 months, with most strictures diagnosed between 6 and 12 months after surgery. Left-sided strictures were most frequent (50%), followed by right-sided and bilateral strictures (25% each). Mono-J drainage was successful in 40% of patients. Conclusion: UIAS remains a clinically relevant complication after Bricker urinary diversion. Early detection, decompression when required, and structured long-term surveillance are important for preserving renal function.