Is there any evidence that one continent diversion is any better than any other or than ileal conduit?
OBJECTIVE
There is an obvious discrepancy between the perceived advantages of the different forms of continent urinary diversion from an expert's point of view and the limited utilization of these techniques outside of academic and tertiary referral centers.


RESULTS
The vast majority of studies are retrospective with numerous confounding factors and often poorly defined outcomes. The rates of postoperative morbidity and need for reoperation varies widely among studies, even for the same procedure. The utilization of continent diversion depends on demographic, socioeconomic, provider-based, and clinical variables, with low case volume and lack of experience probably being the most obvious reasons for avoidance of more complex techniques. In contrast to the prevailing notion that patients undergoing continent diversion have superior quality of life than those receiving a conduit, existing studies fail to show significant advantages of one technique over the other.


CONCLUSIONS
The current body of published literature is insufficient to conclude that there is a superior form of urinary diversion in terms of evidence-based medicine. It is quite clear, however, that not all patients are candidates for one type of diversion. The best results are obtained when a comprehensive concept is tailored to the individual patient.
Gerharz
Elmar W
EW
Department of Urology, Julius Maximilians University Medical School, Würzburg, Germany. gerharz_e@klinik.uni-wuerzburg.de
D002983:Clinical Competence; D019317:Evidence-Based Medicine; D006801:Humans; D017060:Patient Satisfaction; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000193:education / Q000379:methods*; D016476:Urinary Reservoirs, Continent