Archivio Italiano di Urologia e Andrologia 2021; 93, 3 262 ORIGINAL PAPER No conflict of interest declared. the Bricker ureteral implantation in an end-to-side fash- ion using running sutures (7). According to the literature, the ureteroileal stricture (UIS) rate using this technique ranges between 3%-20% (7-10). A frequently used anas- tomotic technique in urinary diversions is that described by Wallace, in which the end of the intestine is sutured to the end of the ureter (11). It is already known that this technique has the lowest complication rate comparing to other ureterointestinal anastomosis (12), including its usage in orthotopic bladder reservoirs (13, 14). Nevertheless, only a few studies favour this technique in orthotopic neobladder (5, 6, 15). The objective of this study was to establish the reliability of technique selection strategy for ureteroileal anastomo- sis, based upon patients characteristics; additionally, we aimed to compare perioperative outcomes and ureteroileal anastomotic stricture rate in a contemporary series of patients who underwent open RC followed by reconstruction of modified Hautmann neobladder. MATERIALS AND METHODS Study design and patients We compared 30 matched paired patients who under- went Hautmann neobladder with single chimney and Bricker anastomotic technique (2, 3) with 30 matched paired patients who underwent Hautmann neobladder with chimney modification consisting of a longer ureter- al spatulation (3-4 cm) combined with end-to-end ureteroileal anastomosis (Wallace type I) and 6-8 cm long isoperistaltic tubularised chimney (16). Long-term results, including uretero-ileal stenosis (UIS) and postoperative complications rate (graded according to Clavien-Dindo system) at 2-year follow-up, were avail- able for analysis. The main differences between techniques were the length of the ureteral spatulation, the chimney size and the end- to-end running suture ureteroileal anastomosis (Figure 1). Patient characteristics included three aspects: ureteral length after retro-sigmoidal tunneling, chimney size and diameter of distal ureter after dissection and preparation for anastomosis. When the ureteral length was similar on Objective: We aimed to establish the reliabil- ity of technique selection strategy for ureteroileal anastomosis (Bricker vs. Wallace) by comparing perioperative outcomes, complications, and anastomotic stric- ture rate in a contemporary series of patients who underwent open radical cystectomy followed by reconstruction of modified Hautmann neobladder. Materials and methods: A total of 60 patients underwent radical cystectomy and modified Hautmann neobladder, of whom 30 patients (group I) with Bricker anastomotic technique were com- pared to 30 matched paired patients with end-to-end ureteroileal anastomosis (group II). Long-term results, including ureteroileal stricture (UIS) and postoperative complication rate at two year follow up were available. The choice of anastomosis type was successively based on chimney size, ureteral length after retro-sigmoidal tunneling and diameter of distal ureter. Postoperative complications were graded according to the Clavien-Dindo system. Results: Ureteroileal stricture rate was 6.6% in group I vs. 0% in group II, after three months (p < 0.05), while anastomotic leak- age rate was 6.6% vs. 3.3% (group I vs group II) between the two groups for the same follow up period (p > 0.05). High-grade complications (Clavien III-V) were more in Bricker group as compared to Wallace group and the difference was significant (20% vs 10.3%, p = 0.03). Conclusion: Our preliminary outcomes demonstrate that this selection strategy seems to be clinically reliable, with lower inci- dence of postoperative complications in Wallace group. KEY WORDS: Orthotopic bladder substitution; Urinary diversion; Reconstructive urology; Selection strategy; Surgical technique. Submitted 25 May 2021; Accepted 25 June 2021 INTRODUCTION In both male and female patients, orthotopic bladder sub- stitution has become the preferred method of urinary diversion post radical cystectomy (RC) for malignant dis- ease (1). Among different reconstructive modalities, ileal neobladder with Hautmann or Studer reservoir is a fre- quent orthotopic diversion and several modified tech- niques have been described (2-6). The standard technique for uretero-enteric anastomosis is Technique selection of ureteroileal anastomosis in hautmann ileal neobladder with chimney modification: Reliability of patient-based selection strategy and its impact on ureteroentric stricture rate Dejan Djordjevic 1 , Svetomir Dragicevic 1 , Marko Vukovic 2 1 Urology Clinic, Euromedik General Hospital, Belgrade, Serbia; ² Urology clinic, Clinical centre of Montenegro, Podgorica, Montenegro. DOI: 10.4081/aiua.2021.3.262 Summary