What is included in urinary diversion and reconstruction performed during radical cystectomy?

Updated: Nov 27, 2016
  • Author: Michael Christopher Large, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Many methods of urinary diversion following radical cystectomy are possible. These methods can be classified into 3 categories: incontinent urinary diversions, continent cutaneous urinary diversions, and orthotopic ileal neobladders.

Pelvic ileal neobladder ready for anastomosis to t Pelvic ileal neobladder ready for anastomosis to the urethra.

For a more detailed description of these 3 categories, see Intraoperative details or the Medscape Reference article Urinary Diversions and Neobladders.

Briefly, an ileal conduit is technically the easiest and quickest method of urinary diversion to perform. Continent cutaneous urinary diversions require intermittent catheterization of a small periumbilical stoma and obviate the need for a stoma bag. The major advantages of neobladders include improved body image and the lack of a stomal device; however, they are contraindicated in some patients, including women with tumor involvement of the bladder neck and most men with prostatic stromal or urethral involvement. Relative contraindications to neobladder include a radiated pelvis, advanced age (lower continence rates), azotemia, and liver dysfunction. Complications of all types of urinary diversion include the following:

  • Hyperchloremic metabolic acidosis

  • Urinary tract infections

  • Stomal-peristomal inflammation, hernia, or stenosis

  • Urinary calculi

  • Vitamin B-12 deficiency

  • Ureterointestinal stenosis leading to hydronephrosis

Zabell et al conducted a study in a large, population-based cohort to compare the risk of end-stage renal disease in patients who received either ileal conduit urinary diversion or continent urinary diversion after cystectomy for bladder cancer. The investigators concluded that there was no significant difference in the rate of end-stage kidney disease for ileal conduit urinary diversion and continent urinary diversion. [17]


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