Clinical Application and Outcomes of a Modified Nipple Technique for Uretero-Ileal Conduit Anastomosis During Ileal Conduit Diversion.

PURPOSE: Anastomotic stricture following uretero-ileal conduit anastomosis remains a difficult clinical dilemma after radical cystectomy, predisposing to upper urinary tract obstruction and renal impairment. We aimed to describe an altered nipple technique for uretero-ileal conduit anastomosis and determine its safety, efficacy, and anti-reflux effect compared with conventional techniques. METHODS: Single institution retrospective series of 32 sequential patients with bladder cancer undergoing radical cystectomy and ileal conduit urinary diversion with the modified nipple technique (July 2013 ∼ October 2023). All cases were performed in a tertiary academic center with adequate follow-up. Radical cystectomy was followed by creation of ileal conduit. 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, 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 had open, 14 laparoscopic, and 1 converted open radical cystectomy. 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 single-center location, lack of standardized renal function laboratory data, and exclusion of minimally invasive or neobladder cases. CONCLUSIONS: The modified nipple technique is a feasible and effective innovation that reduces the incidence of uretero-ileal anastomotic stricture and postoperative complications, potentially improving long-term outcomes.