Chopra Sameer, Abreu Andre L C, Gill Inderbir S
Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Curr Opin Urol. 2016 Jan;26(1):107-13. doi: 10.1097/MOU.0000000000000248.
To review current status and controversies on robotic intracorporeal urinary diversion (RICUD). We discuss the current status of urinary diversion, including complications and current types of RICUD, the available options for RICUD going forward for robotic radical cystectomy (RRC) patients, and the current critiques of RICUD.
Although the majority of centers conclude RRC with an extracorporeal urinary diversion (ECUD), the number of total RICUD being performed worldwide is increasing. Although limited, ICUD may provide comparable, if not superior, outcomes to ECUD, though at the moment this technique has been performed mostly by highly experienced and skilled robotic surgeons who have performed a high volume of ICUDs. Several ICUD options are available, and improvements and increased experience with this technique can lead to comparable outcomes; however, this is yet to be validated.
At the current moment ECUD is still the norm following RRC. However, ICUD is gaining steam and becoming more commonly used. Several urinary diversion options can be accomplished intracorporeally including continent and noncontinent orthotopic and nonorthotopic urinary diversions. Further experience with these techniques by additional centers is required.
综述目的：回顾机器人体内尿流改道（RICUD）的现状及争议。我们讨论尿流改道的现状，包括并发症及当前RICUD的类型、机器人根治性膀胱切除术（RRC）患者未来可行的RICUD选择以及当前对RICUD的批评。
最新发现：尽管大多数中心采用体外尿流改道（ECUD）完成RRC，但全球范围内进行的RICUD总数正在增加。尽管有限，但体内尿流改道（ICUD）可能提供与ECUD相当甚至更好的结果，不过目前这项技术大多由经验丰富、技术娴熟且进行过大量ICUD手术的机器人外科医生实施。有几种ICUD选择，随着这项技术的改进和经验增加可能会带来相当的结果；然而，这一点尚未得到验证。
总结：目前，RRC术后ECUD仍是常规做法。然而，ICUD正在兴起并越来越常用。几种尿流改道选择可在体内完成，包括可控和不可控的原位及非原位尿流改道。其他中心需要对这些技术积累更多经验。
