Albers P
Klinik für Urologie, Klinikum Kassel GmbH, Kassel.
Urologe A. 2004 Aug;43(8):997-1009; quiz 1010. doi: 10.1007/s00120-004-0665-8.
Urinary diversions become necessary in cases of a tumor-bearing urinary bladder requiring cystectomy or a nonfunctioning urinary bladder, e.g., due to neurogenic disorders. In order to choose the ideal urinary diversion, long-term function as well as complication rates, quality of life issues, and patient's acceptance become matters of debate. In this regard, orthotopic diversions are usually the first choice. However, there are contraindications for an orthotopic bladder substitute and sometimes the decision has to be made intraoperatively. Therefore, urinary diversions should only be offered by uro-oncological centers that are capable of performing different kinds of diversions. For many decades incontinent diversions have been the standard of care and for 20 years different kinds of cutaneous and orthotopic continent reservoirs have been performed. Bladder substitutes by means of tissue engineering, however, are still experimental.
对于患有需要膀胱切除术的带瘤膀胱或无功能膀胱（例如由于神经源性疾病）的情况，尿流改道变得必要。为了选择理想的尿流改道方式，长期功能以及并发症发生率、生活质量问题和患者的接受度都成为了争论的焦点。在这方面，原位改道通常是首选。然而，原位膀胱替代存在禁忌症，有时必须在术中做出决定。因此，尿流改道应该仅由能够进行不同类型改道的泌尿肿瘤中心提供。几十年来，非可控性改道一直是标准的治疗方式，并且在过去20年里已经开展了不同类型的皮肤和原位可控性贮尿囊手术。然而，通过组织工程进行膀胱替代仍处于实验阶段。
