title: Urinary diversion: how experts divert.
abstract: OBJECTIVE
  To determine the rates of the available urinary diversion options for patients treated with radical cystectomy for bladder cancer in different settings (pioneering institutions, leading urologic oncology centers, and population based).
  
  
  METHODS
  Population-based data from the literature included all patients (n = 7608) treated in Sweden during the period 1964-2008, from Germany (n = 14,200) for the years 2008 and 2011, US patients (identified from National Inpatient Sample during 1998-2005, 35,370 patients and 2001-2008, 55,187 patients), and from Medicare (n = 22,600) for the years 1992, 1995, 1998, and 2001. After the International Consultation on Urologic Diseases-European Association of Urology International Consultation on Bladder Cancer 2012, the urinary diversion committee members disclosed data from their home institutions (n = 15,867), including the pioneering institutions and the leading urologic oncology centers. They are the coauthors of this report.
  
  
  RESULTS
  The receipt of continent urinary diversion in Sweden and the United States is <15%, whereas in the German high-volume setting, 30% of patients receive a neobladder. At leading urologic oncology centers, this rate is also 30%. At pioneering institutions up to 75% of patients receive an orthotopic reconstruction. Anal diversion is <1%. Continent cutaneous diversion is the second choice.
  
  
  CONCLUSIONS
  Enormous variations in urinary diversion exist for >2 decades. Increased attention in expanding the use of continent reconstruction may help to reduce these disparities for patients undergoing radical cystectomy for bladder cancer. Continent reconstruction should not be the exclusive domain of cystectomy centers. Efforts to increase rates of this complex reconstruction must concentrate on better definition of the quality-of-life impact, technique dissemination, and the centralization of radical cystectomy.
authors.affiliation: Department of Urology, University of Ulm, Ulm, Germany. Electronic address: richard.hautmann@uni-ulm.de.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Hautmann
authors.affiliation: Department of Urology, Mansoura University, Mansoura, Egypt.
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol-Enein
authors.affiliation: Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Cheryl T
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Department of Urology, Skane University Hospital, Malmö, Sweden.
authors.forename: Wiking
authors.initials: W
authors.lastname: Mansson
authors.affiliation: Department of Urology, The Norfolk and Norwich University Hospital, United Kingdom.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Mills
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.affiliation: Institute of Urology, University of Southern California, Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, CA.
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.affiliation: Department of Urology, Inselspital Bern, Bern, Switzerland.
authors.forename: Urs E
authors.initials: UE
authors.lastname: Studer
authors.affiliation: Department of Urology, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Thueroff
authors.affiliation: Department of Urology, Klinikum Kassel, Kassel, Germany.
authors.forename: Bjoern G
authors.initials: BG
authors.lastname: Volkmer
mesh_terms: D015653:Cystectomy; D005858:Germany; D006801:Humans; D010818:Practice Patterns, Physicians'; D013548:Sweden; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods* / Q000706:statistics & numerical data