Abstract
When urinary diversion is indicated, patient information concerning the advantages and disadvantages of different types of urinary diversion and their choices is of utmost importance for the functional outcome and patient satisfaction. There is a variety of choices for incontinent urinary diversion (ureterocutaneostomy, ileal conduit, colonic conduit) and continent urinary diversion (continent anal urinary diversion, continent cutaneous urinary diversion and urethral bladder substitution). In the individual case, the choices may be limited by patient criteria and/or medical criteria. Important patient criteria are preference, age and comorbidity, BMI, motivation, underlying disease and indication for cystectomy. Medical criteria which possibly limit choices of type of urinary diversion are kidney function/upper urinary tract status and limitations concerning the gastrointestinal tract, concerning urethra/sphincter as well as the ability and motivation to perform intermittent self-catheterization. Preoperative information may use simulation of certain postoperative scenarios (urethral self-catheterization, fixation of water-filled conduit bags, holding test for anal liquids) to allow the individual patient to choose the optimal type of urinary diversion for his/her given situation from the mosaic of choices and possible individual limitations.
Published Version
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