title: Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes.
abstract: BACKGROUND
  The urinary reconstructive options available after radical cystectomy (RC) for bladder cancer are discussed, as are the criteria for selection of the most appropriate diversion, and the outcomes and complications associated with different diversion options.
  
  
  OBJECTIVE
  To critically review the peer-reviewed literature on the function and oncological outcomes, complications, and factors influencing choice of procedure with urinary diversion after RC for bladder carcinoma.
  
  
  METHODS
  A Medline search was conducted to identify original articles, review articles, and editorials on urinary diversion in patients treated with RC. Searches were limited to the English language. Keywords included: 'bladder cancer', 'cystectomy', 'diversion', 'neobladder', and 'conduit'. The articles with the highest level of evidence were selected and reviewed, with the consensus of all of the authors of this paper.
  
  
  RESULTS
  Both continent and incontinent diversions are available for urinary reconstruction after RC. In appropriately selected patients, an orthotopic neobladder permits the elimination of an external stoma and preservation of body image without compromising cancer control. However, the patient must be fully educated and committed to the labour-intensive rehabilitation process. He must also be able to perform self-catheterisation if necessary. When involvement of the urinary outflow tract by tumour prevents the use of an orthotopic neobladder, a continent cutaneous reservoir may still offer the opportunity for continence albeit one that requires obligate self-catheterisation. For patients who are not candidates for continent diversion, the ileal loop remains an acceptable and reliable option.
  
  
  CONCLUSIONS
  Both continent and incontinent diversions are available for urinary reconstruction after RC. Orthotopic neobladders optimally preserve body image, while continent cutaneous diversions represent a reasonable alternative. Ileal conduits represent the fastest, easiest, least complication-prone, and most commonly performed urinary diversion.
authors: James Buchanan Brady Foundation, Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors: Richard K
authors: RK
authors: Lee
authors: Hassan
authors: H
authors: Abol-Enein
authors: Walter
authors: W
authors: Artibani
authors: Bernard
authors: B
authors: Bochner
authors: Guido
authors: G
authors: Dalbagni
authors: Siamak
authors: S
authors: Daneshmand
authors: Yves
authors: Y
authors: Fradet
authors: Richard E
authors: RE
authors: Hautmann
authors: Cheryl T
authors: CT
authors: Lee
authors: Seth P
authors: SP
authors: Lerner
authors: Armin
authors: A
authors: Pycha
authors: Karl-Dietrich
authors: KD
authors: Sievert
authors: Arnulf
authors: A
authors: Stenzl
authors: Georg
authors: G
authors: Thalmann
authors: Shahrokh F
authors: SF
authors: Shariat
mesh_terms: D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D010380:Peer Review; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods; D016476:Urinary Reservoirs, Continent
keywords: bladder cancer; outcome assessment (health care); patient selection; radical cystectomy; urinary bladder neoplasms; urinary diversion