title: Urinary diversion: long-term functional aspects.
abstract: Functional aspects and quality of life (QOL) of patients with a urinary diversion (UD) represent important issues in Urology. Any form of UD has its specific problems. In experienced hands and with regular long-term follow-up, serious complications can be avoided and excellent long-term results can be achieved. Thus, the selection of an appropriate UD is critical to patient's long-term satisfaction. Patients must be fully counseled in all types of UD and should have ready access to all options. There are 3 kinds of factors to be considered in the selection of UD: patient, physician, and general factors. In the pre-operative counseling, it is mandatory to explain all factors that over time may contribute to affect the patient's urinary tract function and QOL, mainly linked to long-term complications of UD. One of the most important requirements for any bladder substitution is that it should not jeopardize the renal function. There are many urological and non-urological potential reasons for deterioration in renal function following UD. Continence results after neobladder (NB) are difficult to compare between series published in the literature because of a lack of consensus of definitions, varied follow-up periods, and different mechanisms of data collection. In up to 22% of patients with NB, significant residual urine volumes were observed. The overall patients' QOL reported in most articles was good, irrespective of the type of UD. QOL of patients with a well functioning NB seems to be significantly better than other forms of diversion. Well-designed randomized prospective trials are warranted to render definitive conclusions.
authors.affiliation: Urology Clinic, Department of Surgery, University of Verona & AOUI, Verona - Italy.
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Cerruto
mesh_terms: D015415:Biomarkers; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007258:Informed Consent; D007408:Intestinal Absorption; D007668:Kidney / Q000503:physiopathology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D011788:Quality of Life; D012189:Retrospective Studies; D017741:Survivors / Q000523:psychology; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000601:surgery; D014547:Urinary Diversion / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D014549:Urinary Incontinence / Q000453:epidemiology; D014571:Urologic Neoplasms / Q000601:surgery
chemical_list: D015415:Biomarkers