Incontinent or continent urinary diversion: how to make the right choice

Abstract

To summarize recently published findings regarding functional and health-related quality of life (HRQOL) outcomes associated with conduit and continent urinary diversion, review the evidence (or lack thereof) supporting one diversion type over another, and discuss important factors that impact how patients should likely be counseled regarding choosing between conduit and continent urinary diversions following bladder removal. Functional and HRQOL outcomes have become an important aspect of outcome assessment following urinary diversion. Early research has been limited by the lack of disease-specific instruments and a dearth of reliable, responsive and valid measures. Recently, several disease-specific HRQOL questionnaires have been developed using more robust methods and are in the early phase of outcome assessment. Ultimately, data from these assessments may be used to aid in the decision-making process. However, to date, surveys have not exhibited significant differences when comparing various diversion types, including ileal conduit and orthotopic continent neobladder. A review of the recent literature confirms this finding. Instead of attempting to prove the superiority of one diversion type over another, future studies should endeavor to evaluate the relationship between preoperative health status, diversion choice based on patient preference, and postoperative clinical outcomes. Although postoperative HRQOL outcomes are an important component of counseling prior to urinary diversion procedures, the decision-making process concerning the appropriate type of diversion involves patient education, participation, and in-depth discussion of patient preferences given the preference-sensitive nature of choosing between a conduit and continent diversion.