Urinary diversion in conjunction with radical cystectomy in bladder cancer patient

Han, Chang Hee; Yoon, Moon Soo

Abstract

Several different methods of urinary diversion currently are available in conjunction with radical cystectomy. We reviewed our last 30 months of experience with diversion in 56 patients with bladder cancer undergoing surgery from May, 1990 through October. 1992 and focused on the decision- making process used to select the type of diversion. The results obtained were as follows. 1. Of the 56 patients. 27 patients had a diversion with an external appliance (26 via an ileal conduit and 1 via a cutaneous ureterostomy), 15 patients had a diversion with a continent urinary reservoir(Indiana pouch) and 14 patients had a diversion with an internal reservoir anastomosed to the urethra( 13 via an ileocolic neobladder and 1 via a Camey procedure). 2. The ileal conduit was evenly performed during the period. But the Indiana pouch was more performed between May 1990 and April 1991 and the ileocolic neobladder was mainly per formed since May 1991. 3. There were 50 men and 6 women. The majority of female patients (83%) underwent the Indiana pouch. The ileocolic neobladder was performed in patients who were relatively young and in good medical condition. 4. Urodynamic studies of the Indiana pouch and ileocolic neobladder performed at 6 months postoperatively showed low pressure, large capacity reservoir and high outlet (plicated ileum or urethra) resistance. All patients achieved satisfactory continence during the day. However.1 or 13 patients who underwent the ileocolic neobladder was incontinent at night. In conclusion. there are inherent advantages and disadvantages to each form of urinary diversion. Our general policy is the ileal conduit remains the most wise diversion in most patients but the alternative methods may be reasonable in certain circumstances and patients selection will be important to identify the most appropriate method of diversion for individual. Though the follow-up period is not long enough. Indiana pouch and ileocolic neobladder met the demands for ideal form of urinary diversion. With improvement in the technical aspects or the continent and internal functional reservoir, the number of patients having these reservoirs will increase.