External continent diversion. Technical aspects and development principles

Abstract

The Authors briefly review the evolution of urinary diversion techniques. The introduction of the ileal conduit (Bricker) was the most important step to construction of continent pouches, both external and orthotopic, which share most surgical principles (intestinal detubularization, adequate capacity of the pouch, anti-reflux system for the ureters). External pouches present, as-an additional surgical challenge, the technical problems related to the construction of the continent valve at the stoma site: it is therefore not surprising that they are being performed with decreasing frequency. On the other hand there is increasing interest in the construction of an orthotopic neobladder also in the female patient, where such reconstructive surgery has traditionally been impaired by the anatomo-functional features of the female urethra. The Authors maintain that the following points should be considered with great attention: a) functional border between urethra and bladder neck; b) oncologic border between transitional and stratified epithelium; c) positioning of the pouch within the pelvis; d) trophic condition of the pelvic wall musculature.