Factors influencing the choice of urinary diversion in patients undergoing radical cystectomy.
OBJECTIVE
To examine the rate at which patients undergo various types of urinary diversion (UD) and the reasons why they had the given reconstruction, analysed in the context of a standardized preoperative protocol for patients undergoing radical cystectomy (RC) at our institution, as there is wide variation in the distribution of patients undergoing continent (CUD) vs incontinent (ICUD) after RC.


METHODS
Between September 2004 and December 2008, 200 patients had RC with UD by one surgeon. Each patient was given standardized preoperative counselling; the charts were reviewed retrospectively to determine the relative frequencies of the various types of UD, and the reasons why patients had an ICUD assessed, including medical contraindications and personal choice.


RESULTS
During preoperative counselling, 149 patients (75%) were assessed as being eligible for a CUD, while 51 (25%) had one or more contraindication; 140 (70%) ultimately had a CUD, and the remaining 60 (30%) a ICUD. Of the 149 patients eligible for a CUD, only nine (6%) chose to undergo ICUD for personal reasons.


CONCLUSIONS
Few patients choose to have an ICUD in the absence of an absolute medical contraindication. Proper patient selection and thorough, standardized preoperative counselling result in a higher rate of CUD than ICUD after RC.
Ashley
Matt S
MS
Section of Urologic Oncology, Oregon Health & Science University, Portland, OR 97239, USA.
Daneshmand
Siamak
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D015653:Cystectomy / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*; D016476:Urinary Reservoirs, Continent; D055815:Young Adult