Presently, radical cystectomy and ileal conduit urinary diversion or continent urinary diversion and neobladder reconstruction commonly performed curative surgical treatment option for patients with invasive bladder cancer.The two most common types of ureteroenteric anastomosis during the procedure are the refluxing Bricker and Wallace techniques. In a present study the overall stricture rate was found for Bricker anastamoses %5.7 and for Wallace anastomoses %3.9 (1).
The aim of this study is to show stricture rate and stricture releated interventions about our modified Wallace anastomosis technique.

From Janurary 2008 and January 2018 169 patient who underwent radical cystectomy and diversion enrolled this study. Stricture rates and stricture releated symptoms and interventions documanted retrospectively. Bricker or Wallace techniques performed 102 patient, and our modified Wallace technique performed 69 patient.

After the cystectomy completed both ureters are gently mobilized with meticulous dissection to preserve vascular supply. Left ureter is transferred to the contralateral site under the sigmoid colon at the level of sacral promontorium.  Then a 15 centimeters long ileal segment is taken if the procedure is planned to proceed with ileal loop or a 45 centimeters ileal segment is taken and the proximal 7 to 8 centimeters is left intact as a chimney if a continent neobladder is to be created. 
Medial walls of both ureters are incised 5 centimeter and spatulated. A 4/0 Vicryl suture is passed through the corners of the proximal ends of the incisions and tied with the knot outside. The spatulated edges of the both ureters are sutured to the opposite site with 4 to 5 single 4/0 Vicryl sutures and distal ends of the both ureters form a single unit. Two 4/0 Vicryl sutures are passed through the corners of the distal ends of each ureteral unit and relevant sites on the ileal segment and tied. Then ureteroileal anastomosis is completed with these two sutures on each site in continuous fashion. First, posterior site is completed and 6F feeding tubes or mono-J ureteral catheters are negotiated into the ureters before completing the anterior site anastomosis. İleal segment or neobladder is filled with saline and anastomosis is checked for water-tightness.

In Bricker or Wallace anastomosis groups stricture was observed 17 (%16) patient. 10 of them had mild dilatation and had no pain or renal functional detorations so they managed consevativelly, not performed any intervention and followed up. 5 of them had mild dilatation and they had pain or renal functional detorations and antegrade or retrograde baloon dilatations was performed. After removing jj stent mild dilatation was observed in 1 patient and treat baloon dilatation again succesfully. 2 of them had severe hydroureteronephrosis and renal detoration and open anatomosis revision was performed .
In modified Wallace anastomosis group only 2 (%2.9) patient had mild dilatation and they managed consevativelly, not performed any intervention and followed up.

Although Bricker and Wallace surgical techniques remain the two most common methods of ureteroenteric anastomosis for ileal conduit, there is little comparative data on their associated outcomes. Early studies have described complication rates relating to the ureteroenteric anastomosis ranging from 1.7% to 14% for both techniques (2,3). The present review demonstrated that no statistically significant difference in the rates of ureteroenteric stricture for Bricker and Wallace anastomotic techniques. 
Stricture rate of our anastomosis technique is comperable with literature and not required any further invasive treatment modalities is a plus.

Our modified Wallace anastomosis technique is safe, practible, feasibl and have less stricture risk.

Davis NF, Burke JP, McDermott T, Flynn R, Manecksha RP, Thornhill JA. Bricker versus Wallace anastomosis: A meta-analysis of ureteroenteric stricture rates after ileal conduit urinary diversion. Can Urol Assoc J. 2015 May-Jun;9(5-6):E284-90
Farnham SB, Cookson MS. Surgical complications of urinary diversion. World J Urol. 2004;22:153–60
Pantuck AJ, Han KR, Perrotti M, et al. Ureteroenteric anastomosis in continent urinary diversion: Long-term results and complications of direct versus nonrefluxing techniques. J Urol. 2000;163:450–5