Urinary complications following Bricker urinary diversion in gynecologic cancer: A retrospective analysis of 77 cases

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.