Our Summary

This research paper is about a procedure called orthotopic urinary diversion, which has been done for over 30 years. This procedure is often considered the best option in many specialist centers, but it’s not commonly done elsewhere. The paper’s goal is to look at the current uses and results of this procedure, specifically in male patients, and to understand why it’s not more widely used.

The paper found that around 75% of patients who need a radical cystectomy (a surgery to remove the bladder) could have this procedure. Despite this, very few patients choose to have it, often opting for a different procedure called an ileal conduit for personal reasons. However, a recent study found that patients who had the orthotopic diversion had a better overall health status and physical function than those who had the ileal conduit.

The paper also looked at two types of orthotopic diversion - one where urine can flow back into the bladder (refluxing) and one where it can’t (nonrefluxing). After three years, there was no difference in kidney function between the two.

Currently, there’s not enough evidence to say that using less invasive techniques leads to better results during and after surgery.

In conclusion, there are very few reasons not to have an orthotopic diversion, and it’s still considered the best option at many specialist centers. The experience of the surgeon and proper preparation before surgery, including setting realistic expectations, can help to make sure the procedure is as successful as possible and that the patient is satisfied with the results.

FAQs

  1. What is orthotopic urinary diversion and how common is its use?
  2. What are the current indications and outcomes of orthotopic diversion in male patients?
  3. Is there evidence to suggest improved perioperative outcomes with the use of minimally invasive techniques in urinary diversion surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about urinary diversion surgery is to thoroughly discuss and understand the potential risks and benefits of orthotopic diversion, as well as to have realistic expectations for the surgery and recovery process. It is important for patients to work closely with their healthcare team, including their surgeon and urologist, to ensure optimal outcomes and satisfaction with their choice of diversion. Additionally, following post-operative care instructions and attending regular follow-up appointments are essential for monitoring and maintaining overall health and well-being.

Suitable For

Patients who are typically recommended for urinary diversion surgery include those undergoing radical cystectomy for bladder cancer, patients with neurogenic bladder dysfunction, and patients with refractory bladder pain or recurrent urinary tract infections. In particular, male patients may benefit from orthotopic diversion due to the potential for improved quality of life and preservation of sexual function compared to ileal conduit diversion. Patients who are motivated and willing to adhere to postoperative care and follow-up appointments are also good candidates for urinary diversion surgery.

Timeline

Before urinary diversion surgery:

  1. Initial consultation with a urologist to discuss treatment options for bladder cancer or other conditions requiring urinary diversion.
  2. Preoperative testing and evaluation to determine candidacy for orthotopic diversion, including imaging studies and blood tests.
  3. Education and counseling about the surgery, potential risks and complications, and postoperative care.
  4. Decision-making process regarding the choice of diversion technique, such as orthotopic neobladder or ileal conduit.
  5. Surgical preparation, including bowel preparation and cessation of certain medications.

After urinary diversion surgery:

  1. Hospitalization for the surgery, which typically lasts several days to a week.
  2. Recovery period at home, including pain management and monitoring for complications.
  3. Follow-up appointments with the urologist for monitoring of the neobladder or conduit, and adjustment of medications as needed.
  4. Rehabilitation and physical therapy to regain bladder function and learn how to manage the new urinary system.
  5. Long-term follow-up care to monitor for complications, such as urinary tract infections or kidney function changes, and address any concerns or issues that may arise.

What to Ask Your Doctor

  1. Am I a candidate for orthotopic urinary diversion?
  2. What are the potential benefits of orthotopic diversion compared to other forms of diversion?
  3. What are the potential risks and complications associated with orthotopic diversion surgery?
  4. What is the expected recovery time and long-term outcome of orthotopic diversion?
  5. How often will I need to follow up with my doctor after the surgery?
  6. Will I need any additional treatments or medications after the surgery?
  7. How will the surgery affect my daily activities and quality of life?
  8. Are there any lifestyle changes or dietary restrictions I will need to adhere to after the surgery?
  9. What is the success rate of orthotopic diversion in terms of maintaining renal function and overall health?
  10. How experienced are you in performing orthotopic diversion surgeries, and what is your success rate with this procedure?

Reference

Authors: Daneshmand S. Journal: Curr Opin Urol. 2015 Nov;25(6):545-9. doi: 10.1097/MOU.0000000000000226. PMID: 26414610