Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes

Abstract

Extra-institutional Funding: None. Context• The urinary reconstructive options available after radical cystectomy (RC) 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. Objective• To critically review the peer-reviewed literature on the function and oncological outcomes, complications, and factors influencing choice of procedure with urinary diversion after RC for bladder carcinoma. Evidence Acquisition• A Medline search was conducted to identify original articles, review articles, and editorials on urinary diversion in patients treated with RC. Searches were limited to the English language. • Keywords included: 'bladder cancer' , 'cystectomy' , 'diversion' , 'neobladder' , and 'conduit' . • The articles with the highest level of evidence were selected and reviewed, with the consensus of all of the authors of this paper. Evidence Synthesis• Both continent and incontinent diversions are available for urinary reconstruction after RC. In appropriately selected patients, an orthotopic neobladder permits the elimination of an external stoma and preservation of body image without compromising cancer control. However, the patient must be fully educated and committed to the labour-intensive rehabilitation process. He must also be able to perform self-catheterisation if necessary.• When involvement of the urinary outflow tract by tumour prevents the use of an orthotopic neobladder, a continent cutaneous reservoir may still offer the opportunity for continence albeit one that requires obligate self-catheterisation. • For patients who are not candidates for continent diversion, the ileal loop remains an acceptable and reliable option. Conclusions• Both continent and incontinent diversions are available for urinary reconstruction after RC.• Orthotopic neobladders optimally preserve body image, while continent cutaneous diversions represent a reasonable alternative.• Ileal conduits represent the fastest, easiest, least complication-prone, and most commonly performed urinary diversion.Keywords bladder cancer, outcome assessment (health care), patient selection, radical cystectomy, urinary bladder neoplasms, urinary diversion

Does Robot-Assisted Approach to Radical Cystectomy Influence Surgeon Choice for Urinary Diversion?

“…Absolute contraindications for CUD included impaired renal function (estimated Glomerular Filtration Rate (eGFR) <50 mL/ min), hepatic dysfunction, physical or mental impairment precluding Intermittent Self Catheterization (ISC), positive urethral margins (or bladder neck in females), and unmotivated patient. Relative contraindications included associated multiple comorbidities American Society of Anesthesiologists (ASA) score ≥3, advanced age, extensive disease with high risk of recurrence or the possible need for adjuvant therapy, prior pelvic irradiation, bowel and urethral disease (Supplementary Table 1) [8].…”

Quality of Life after Radical Cystectomy and Diversion

“…Bunlar kondüitler, kutaneöz kontinan diversiyonlar ve ortotopik mesanelerdir. Son yıllarda ortotopik mesane ameliyatları sayıca artmışsa da halen tüm dünyada mesane kanseri için yapılan diversiyonların büyük kısmında kondüitler içinde altın standart olarak kabul edilen ileal kondüit kullanılmaktadır (33). Dolayısı ile yaşam kalitesi araştırmalarının çoğu ileal kondüit ile diğer teknikler karşılaştırılarak yapılmıştır.…”

Early and Late Complications of Urinary Diversions after Radical Cystectomy

“…Hasta ile ilgili bazı özellikler kompleks üriner diversiyonlar için kontrendikasyon oluşturmaktadır. Kompleks üriner diversiyonlar için kesin kontrendikasyonlar arasında böbrek ve karaciğer fonksiyon bozukluğu, yıpratıcı nörolojik veya psikiyatrik hastalık varlığı, sınırlı yaşam beklentisi, fiziksel veya mental olarak temiz aralıklı kateterizasyona uygun olmayan hastalar ve üretral sınırda veya diğer cerrahi sınırlarda pozitif değişici hücreli kanser varlığıdır (1,3,4). Bunlar dışında rölatif kontrendikasyonlar arasında ileri yaş, adjuvan kemoterapi ihtiyacı, geçirilmiş pelvik radyoterapi, barsak hastalığı ve üretral patoloji ve yaygın hastalık varlığı bulunmaktadır (3).…”