Surgical Management of Bladder Carcinoma

Rafael Carrion, MD, John Seigne, MB

Disclosures

Cancer Control. 2002;9(4) 

In This Article

Choosing a Urinary Diversion

Once the bladder is removed, the urologist is challenged in selecting the appropriate urinary diversion. Several urinary diverting procedures are described in the medical literature. These procedures can be divided into incontinent (ileal conduit and cutaneous urostomy) and continent procedures. The continent procedures can be further subdivided into cutaneous reservoirs (in which the reservoir is connected to the abdominal skin requiring intermittent catheterization) and orthotopic neobladders (in which the reservoir is connected to the urethra). The gold standard in incontinent diversions is the ileal conduit, which is a simple and safe method of diverting the urine, but continuously draining stoma can affect the quality of life of some patients. This disadvantage has led to the development of several continent reconstructive procedures ( Table 2 ). Each form of diversion has its intrinsic advantages and disadvantages. The urologist must analyze a variety of elements before selecting the optimal procedure for that patient. We favor orthotopic neobladders in properly selected patients with continent cutaneous diversion followed by ileal conduit as second and third choices. Several discussions of these choices are reported elsewhere.[42,43]

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