Techniques of Urinary Diversion

Abstract

The urinary reconstructive options available after radical cystectomy for bladder cancer are discussed, as are the criteria for selection of the most appropriate diversion, and the outcomes and complications associated with different diversion options. The morbidity of radical cystectomy and urinary diversion is up to 75 % diversion related and much higher than previously reported. Urinary diversion into bowel segments is not inherently damaging to the kidneys. Indications for a neobladder following radical cystectomy in patients with invasive bladder cancer have significantly widened over the past two decades. A neobladder should be offered to both male and female patients in the absence of contraindications. Good long—term functional and oncologic outcomes can be achieved in patients with neobladder high-volume institutions by experienced surgeons with specific knowledge in the field. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results. Conduit diversions remains the gold standard against whom the other types of diversion have to be measured. Meticulous follow up of any type of diversion is critical to the long-term success.