adequate, and 8 to 10 days of ureteral stenting are sufficient.Last but not least, it is a fact that excellent experiencedsurgeons will generally have a low stricture rate.

Arnulf StenzlDepartment of Urology

University of Tuebingen Medical CenterTuebingen, Germany

1. Stenzl A, Bartsch G and Rogatsch H: The remnant urotheliumafter reconstructive bladder surgery. Eur Urol 2002; 41: 124.

REPLY BY AUTHORS

The Bricker and the Wallace ureteroileal anastomoses haveseveral perceived limitations. The Bricker potentially has ahigher stricture rate and the Wallace can lead to bilateralupper tract compromise given an anastomotic recurrence.Stenzl expresses this potential shortcoming of the conjoinedtechnique and cites the potential for upper tract recurrencein 3% to 18% of patients. However, it must be acknowledged

that most recurrences are not anastomotic recurrences. Sev-eral studies have demonstrated anastomotic recurrences inonly 0% to 0.7% of patients.1–3 Moreover, these patientsoften die of concomitant distant disease. Accordingly, thisperceived limitation of the Wallace technique does not ap-pear clinically or oncologically significant. Ultimately, assuggested by Stenzl, surgeon proficiency and careful opera-tive technique remain perhaps the most important factors inreducing ureteroanastomotic complications.

1. Schumacher MC, Scholz M, Weise ES, Fleischmann A, Thal-mann GN and Studer UE: Is there an indication for frozensection examination of the ureteral margins during cystec-tomy for transitional cell carcinoma of the bladder? J Urol2006; 176: 2409.

2. Schoenberg MP, Carter HB and Epstein JI: Ureteral frozensection analysis during cystectomy: a reassessment. J Urol1996; 155: 1218.

3. Raj GV, Tal R, Vickers A, Bochner BH, Serio A, Donat SM et al:Significance of intraoperative ureteral evaluation at radicalcystectomy for urothelial cancer. Cancer 2006; 107: 2167.

URETEROENTERIC ANASTOMOSIS 949