Which patients are suitable for continent diversion or bladder substitution following cystectomy or other definitive local treatment?

Abstract

In 1982, Kock and associates, reported their experi- ence based on extensive experimental data in 12 pa- tients in whom a detubularized ileal reservoir was constructed for continent urinary diversion utilizing a catheterizable This report has had a major impact on urinary diversion worldwide.' A number of modifications to Kock's original description have been made to reduce complications and the need for reoperation. Others have developed reservoirs from the right colon, sigmoid, and stomach.*' All have been developed in an effort to improve quality of life and a patient's acceptance of the need for cystectomy as primary treatment of bladder cancer. In the mid 1980s, based on the earlier work of Camey,13 several centers began clinical trials of lower urinary tract re- construction in men, utilizing an ileal reservoir with bilateral ureteroileal urethrostomy or various colonic This obviates the need for a stoma and the need for intermittent catheterization. Thus, they have become attractive alternatives for men.