Methods of urinary diversion following radical cystectomy.

This paper describes the three major types of urinary diversion and provides examples of the radical cystectomy patients who might be eligible for each. The ileal conduit is the simplest operative procedure to perform, but it requires the patient to perform a high degree of maintenance and has the greatest impact on self-image because of the need to wear a pouch. This technique is best suited for the medically ill patient at high risk for postoperative complications. The continent reservoir to the abdominal wall creates what is essentially a new bladder. The patient must catheterize the reservoir through a stoma at regular intervals, but no external pouch is required. A healthy patient of either sex is eligible for this procedure. The continent reservoir to the urethra restores nearly normal function. However, it adds several hours to the operative time, it has a somewhat higher rate of postoperative complications than do the other diversion techniques, and women are not eligible. Only highly motivated, healthy men are candidates for this procedure.