[Bladder substitution surgery versus continent diversions].

Abstract

Continent urinary diversion and bladder replacement procedures have been developed in an attempt to improve patient quality of life. When the oncologic objective is not compromised by the choice of diversion procedure, we prefer performing bladder replacement after cystectomy. Herein we discuss the advantages and disadvantages of continent urinary diversion highlighting the standard technique (Brickner). Similarly, the different types of continent diversion procedures and their rationale are discussed. We analyzed a series of 54 cases submitted to tubular and detubularized bladder replacement procedures. The surgical techniques are described with a special focus on mortality and morbidity. The results of the present study revealed preservation of sexual function was achieved in 16%, diurnal and nocturnal continence were achieved in 99.5% and 56%, respectively, and intussusception as an antireflux mechanism was effective in 90%. All the foregoing results have prompted us to continue this approach, particularly since there is no universal diversion or replacement procedure applicable to all patients. On the contrary, the currently available surgical procedures must be selected on the basis of each individual case in order to achieve the best possible results.