title: Orthotopic urinary diversion.
abstract: OBJECTIVE
  Orthotopic urinary diversion has been performed for more than 30 years. Although it is considered to be the gold standard form of diversion in many centers of expertise, however it is uncommonly performed outside these institutions. The purpose of this article is to review the current indications and outcomes of orthotopic diversion with a focus on male patients and to explore potential barriers to wider dissemination of the technique.
  
  
  RESULTS
  Approximately 75% of patients undergoing radical cystectomy today are candidates for orthotopic diversion and in the absence of absolute contraindications, very few patients chose to undergo an ileal conduit for personal reasons. In a recent quality of life study, the orthotopic neobladder was better than ileal conduit in terms of global health status and physical functioning. In a prospective randomized trial comparing a refluxing versus nonrefluxing neobladder, there was no difference in renal function after 3 years. There is currently insufficient evidence to suggest improved perioperative outcomes with the use of minimally invasive techniques.
  
  
  CONCLUSIONS
  There are very few absolute contraindications for an orthotopic neobladder, which remains the gold standard form of diversion at many centers of expertise. Surgeon experience and thorough preoperative counseling with realistic expectations can ensure optimal outcomes and patient satisfaction.
authors.affiliation: USC/Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, California, USA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
mesh_terms: D015653:Cystectomy; D006801:Humans; D008297:Male; D018579:Patient Selection; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D019738:Surgically-Created Structures; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D014549:Urinary Incontinence / Q000209:etiology; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*