Our Summary

This research paper discusses the different types of urinary diversions, which are surgical procedures to reroute urine flow, typically after bladder removal. The type of diversion chosen can significantly impact a patient’s life in terms of potential complications and quality of life. The paper emphasizes the importance of personalizing these procedures to the individual needs of each patient.

To provide personalized surgery, the surgeon needs to be skilled in handling all parts of the gut. This will allow them to adapt to the patient’s unique anatomy, other health conditions, cancer-related factors, prognosis, and social situation. The paper notes that as our population ages and the rate of bladder cancer increases, there’s a growing need for less invasive urinary diversion methods.

The paper also points out that there is limited evidence on which type of urinary diversion is best, due to a lack of well-structured studies. However, the ileum conduit—a procedure where a small piece of the small intestine is used to create a new pathway for urine to exit the body—is currently the most commonly used method worldwide.

In conclusion, while there are multiple urinary diversion techniques available, the key to ensuring the best outcome for patients is to select the method that is safest and provides the highest quality of life for each individual.

FAQs

  1. What is the purpose of urinary diversion surgery?
  2. What factors determine the type of urinary diversion used in surgery?
  3. What is the most commonly used urinary diversion technique worldwide?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about urinary diversion surgery is to discuss with their surgeon the different types of diversions available and to consider factors such as their overall health, lifestyle, and personal preferences when choosing the best option for them. It is important to have a thorough discussion with the surgeon about potential complications, recovery time, and long-term effects of the chosen diversion to ensure the best outcome for the patient. Additionally, following the post-operative care instructions provided by the medical team is crucial for a successful recovery.

Suitable For

Patients who may be recommended urinary diversion surgery typically include those who have undergone cystectomy (removal of the bladder) due to conditions such as bladder cancer, neurogenic bladder dysfunction, or other bladder diseases that cannot be managed with less invasive treatments. Patients who have failed previous bladder reconstruction procedures or have complications from previous surgeries may also be candidates for urinary diversion surgery. Additionally, patients who have a high risk of recurrent bladder cancer or have significant urinary incontinence may benefit from urinary diversion surgery. The choice of urinary diversion type will depend on the individual patient’s anatomy, medical history, preferences, and overall health status.

Timeline

Before urinary diversion surgery:

  • Patient is diagnosed with a condition such as bladder cancer that requires removal of the bladder (cystectomy)
  • Patient undergoes preoperative evaluation and counseling to discuss surgical options
  • Patient may undergo imaging tests and other preoperative procedures to prepare for surgery

After urinary diversion surgery:

  • Patient undergoes surgery to remove the bladder and create a new way for urine to leave the body
  • Patient may have a temporary stoma (opening on the abdomen) for urine to drain into a bag
  • Patient receives postoperative care and monitoring for complications
  • Patient undergoes rehabilitation and adjustment to living with a urinary diversion, which may include learning how to care for the stoma and manage any changes in urinary function
  • Patient may experience improvements in quality of life and overall health after recovery from surgery.

What to Ask Your Doctor

  1. What are the different types of urinary diversion surgeries available and which one would be most suitable for my specific situation?
  2. What are the potential complications and risks associated with urinary diversion surgery?
  3. How long is the recovery process and what can I expect in terms of post-operative care?
  4. Will I need to make any lifestyle changes or modifications after the surgery?
  5. What is the long-term outlook for patients who undergo urinary diversion surgery?
  6. Are there any alternative treatments or options to consider before proceeding with urinary diversion surgery?
  7. How experienced are you in performing urinary diversion surgeries and what is your success rate?
  8. Can you provide me with information on support groups or resources for patients who have undergone urinary diversion surgery?
  9. Will I need to undergo any additional tests or evaluations before scheduling the surgery?
  10. What are the chances of the cancer returning after the surgery and how will that be monitored in the future?

Reference

Authors: Pycha A, Burger M, Palermo S. Journal: Curr Opin Urol. 2015 Sep;25(5):436-40. doi: 10.1097/MOU.0000000000000205. PMID: 26148067