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    Korean J Urol. 2007 Jun;48(6):565-573. Korean.
    Published online Jun 30, 2007.
    https://doi.org/10.4111/kju.2007.48.6.565
    Copyright © 2007 The Korean Urological Association
    Review

    Urinary Diversion: Ileal Conduit to Orthotopic Neobladder Substitution

    Moon Kee Chung, and Ho Kyung Seo1
      • Department of Urology, College of Medicine, Pusan National University, Busan, Korea.
      • 1Urologic Oncology Clinic, National Cancer Center, Goyang, Korea.
    • Corresponding author (Email: mkchung@pusan.ac.kr )

    Abstract

    During the last decade, urinary diversion has evolved from simply diverting the urine through a conduit to continent urinary diversion, especially orthotopic bladder substitution. At present, all the patients undergoing cystectomy are neobladder candidates. In general, if sphincter sparing surgery is possible, then orthotopic bladder substitution is performed; if this can't be done, then continent catheterizable reservoirs or noncontinent cutaneous diversion are viable options. The rate of complications of neobladders is actually similar to the true complication rates after conduit formation, which is in contrast to the popular view that conduits are simple and safe. The need for reflux prevention is not the same as for creating a ureterosigmoidostomy conduit or continent diversion. Reflux prevention in neobladders is even less important than in a normal bladder. When using nonrefluxing techniques, the risk of obstruction is at least twice that after direct anastomosis. Strict patient selection criteria and improved surgical technique have had a positive influence on the outcome, not only on survival but also on quality of life issues. Until a better solution is devised, orthotopic bladder reconstruction remains the best option for patients requiring cystectomy.

    Keywords
    Bladder; Bladder neoplasm; Urinary diversion; Cystectomy

    Tables

    Table 1
    Criteria for ideal urinary diversion

    Table 2
    How the experts divert at medical centers

    Table 3
    Indications for external collecting device diversion

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    MeSH Terms
    Cystectomy
    Humans
    Patient Selection
    Quality of Life
    Urinary Bladder
    Urinary Bladder Neoplasms
    Urinary Diversion*
    Metrics
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