Method of choice for urinary diversion in surgical treatment of bladder carcinoma.

Evidence is presented concerning 94 patients with malignancy of bladder in whom diversion of urine was performed after cystectomy for exclusion of the bladder. There were 80 men and 14 women, ages ranging from 30 to 81 years. In 35 of these 94 cases ureterosigmoidoanastomosis, in 38 cases ureterocutaneostomy, in 15 Portilla's operation, in 2 Bricker's method and in 4 nephro-pyelostomy were performed. For the prevention of bleeding cystectomy was preceded by bilateral ligation of the internal iliac artery in 14 cases. Continuous postoperative follow-up of the patients (from a few months to 14 years) and analysis of the early and late results allow to regard the combined technique of Coffey II-Nesbit-Goodwin as the method of choice having the slightest risk of peritonitis, intestinoureteral reflux and other complications inherent in other procedures. Of the existing methods of ureterocutaneostomy the authors have chosen Le Dentu's method with some modifications. They consider ureterostomy to be the simplest and quickest method owing to the higher location of ureterostoma. Portilla's method is no longer used because of its unfavourable long-term results. Of 94 patients with cancer of the bladder, who had been subjected to different methods of urinary diversion in the years 1954-1974, 16 have survived up till now. There are 10 survivors after ureterosigmoidoanastomosis, 5 after ureterocutaneostomy and 1 after Bricker's operation.