Abstract
Recently, orthotopic bladder replacement is performed in one half of patients after cystectomy - conduit is performed in one third of patients. In the remaining patients anal diversions and continent cutaneous diversions are performed.
If there are no early or late complications, an orthotopic bladder replacement is probably the best option of urinary diversion. Nevertheless, elderly patients tend to have worse continence due to muscular weakness.
Long-term experience with follow-up periods more than 10 years demonstrates a sustained favorable voiding outcome with slightly increased incontinence rates depending on the increasing age of patients. The risk of hypercontinence has to be considered especially in female patients.
Conduits are suitable in patients in poor general condition and in patients with an increased risk of local recurrence or in patients scheduled to radiotherapy. Recovery in patients with anal diversion is very prompt.
Long intervals between micturitions allow the patients to sleep for a longer period of time or even without waking up early after the surgery. Results of continent cutaneous diversion in elderly patients may be influenced by the level of self-service for self-cathererization.
Urinary diversion using more sophisticated methods with many specific steps causes an increased risk of various complications. The most appropriate diversion must be chosen, "tailored" for each patient.
Functional results of any urinary diversion in appropriately selected patients are comparable and depend on careful cystectomy and subsequent meticulous reconstruction.