Urinary Diversion: Historical Aspect and Patient's Satisfaction

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During the last decades, the techniques of urinary diversion have evolved from simple diverting techniques through a conduit to the orthotopic neobladder reconstruction aiming to provide an improved quality of life for patients undergoing radical cystectomy for muscle-invasive bladder cancer. The outcome after cystectomy and continent urinary diversion is not only dependent on surgical technique but restrictive preoperative patient selection and expert perioperative patient management is of equal importance. Urinary diversion techniques are usually limited by two main factors; patient or medical criteria, or both. Important patient criteria are patient's preference, age and co morbidity, body mass index (BMI) and motivation. Medical criteria for choice of the type of urinary diversion are renal function, upper urinary tract status, underlying primary disease, indication for cystectomy and limitations concerning the gastrointestinal tract. Complications after urinary diversion are generally due to the surgical technique, the underlying disease process and its treatment, patient's, co-morbidities and the follow-up period. Patient counseling for better satisfaction about the type and technique of urinary diversion should be tailored to determine the safest method for cancer control, with the least complications along both the short and the long terms, and the easiest comfortable adjustment for a better patients' lifestyle, to obtain the best patients' quality of life. Health-related quality of life (HRQoL) measures should include the patient's physical fitness, the underlying symptoms, global judgment of health, psychological and social well-being, cognitive function, and personal constructs.