title: ICUD-EAU International Consultation on Bladder Cancer 2012: Urinary diversion.
abstract: BACKGROUND
  A summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications.
  
  
  OBJECTIVE
  To review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD).
  
  
  METHODS
  An English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis.
  
  
  RESULTS
  Indications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85-90% and 60-80%, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7% to 50%.
  
  
  CONCLUSIONS
  RC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after surgery, emphasizing the need for lifelong monitoring. Evidence suggests an association between surgical volume and outcome in RC; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results.
authors.affiliation: University of Ulm, Germany. richard.hautmann@uni-ulm.de
authors.forename: Richard E
authors.initials: RE
authors.lastname: Hautmann
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol-Enein
authors.forename: Thomas
authors.initials: T
authors.lastname: Davidsson
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Gudjonsson
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Hautmann
authors.forename: Henriette V
authors.initials: HV
authors.lastname: Holm
authors.forename: Cheryl T
authors.initials: CT
authors.lastname: Lee
authors.forename: Frederik
authors.initials: F
authors.lastname: Liedberg
authors.forename: Stephan
authors.initials: S
authors.lastname: Madersbacher
authors.forename: Murugesan
authors.initials: M
authors.lastname: Manoharan
authors.forename: Wiking
authors.initials: W
authors.lastname: Mansson
authors.forename: Robert D
authors.initials: RD
authors.lastname: Mills
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.forename: Raimund
authors.initials: R
authors.lastname: Stein
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thueroff
authors.forename: William H
authors.initials: WH
authors.lastname: Turner
authors.forename: Bjoern G
authors.initials: BG
authors.lastname: Volkmer
authors.forename: Abai
authors.initials: A
authors.lastname: Xu
mesh_terms: D015653:Cystectomy / Q000009:adverse effects / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D020127:Recovery of Function; D012086:Reoperation; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000592:standards*; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology; D016476:Urinary Reservoirs, Continent / Q000009:adverse effects / Q000592:standards*