Urinary diversion after cystectomy: An Indian perspective

Abstract

Radical cystectomy remains the standard treatment for muscle-invasive carcinoma bladder. Various methods have been described for the urinary diversion. In the last 150 years urinary diversion has evolved from cutaneous ureterostomy to the orthotopic neobladder. Especially during the last 20 years, much advancement has been made. We hereby have reviewed the current approaches being used at different centers in India. We have also analyzed the evolution of diversion from conduit to the orthotopic substitution at our center.

Keywords: Radical cystectomy; conduit; neobladder; urinary diversion.

Figure 1

Pitcher pot ileal neobladder. (A) Excision of 55 cm ileal segment at least 25 cm proximal to ileocaecal junction. Distal 40 cm is opened along antimesenteric border except at apex of ‘U’ where it is opened towards mesenteric border. (B) Completion of posterior plate (C) Neourethral tube constructed. X′, proximal most end of posterior longitudinal suture line; X, proximal point of anterior suture line making neourethral tube; Y′, mid point of anterior wall of the distal detubularized segment; Y, Mid point of anterior wall of the proximal detubularized segment. (D) X′ and X are sutured by rotating X′ end of the detubularized segment to X point. Y0 to X0 and X0 to Y sutured after completion of uretero-intestinal anastomosis thus completing the neobladder construction. Ureteral stents are passed and brought out through the mesentery of the Studer's limb.

Figure 2

Uroflow showing various voiding patterns.