DILATED URETERS ARE RISK FACTOR FOR STRICTURES
The authors present a large single institution series of patients who received an ileal neobladder with long-term followup. They noted that patients with a Le Duc type antireflux ureteroileal anastomosis had a higher anastomotic stricture rate than those who had a refluxing Wallace type anastomosis (more accurately a Bricker or Leadbetter anastomosis). This has already been well documented in the literature, including by the authors themselves in 2011, along with a stricture rate of less than 3% for the Leadbetter approach (references 7 and 18 in article).1 The only new and interesting finding is that ureters that were previously dilated before surgery
had a higher rate of stricture. The main effect was in the Le Duc group, which is not surprising, but there was an increased risk in the refluxing anastomoses as well. That is counterintuitive and must be confirmed by other groups. Possible associations with other proposed risk factors such as comorbidities, obesity, prior stents, urinary infections, etc were not examined and so it is possible this is not a real independent predictor. Eila C. Skinner Department of Urology Stanford University School of Medicine Stanford, California
REFERENCE 1. Skinner DG, Crawford ED and Kauffman JJ: Complications of radical cystectomy for carcinoma of the bladder. J Urol 1980; 123: 640.