[From urostoma to bladder replacement: current possibilities in urinary diversion]. / Van urostoma naar blaasvervanging: nieuwe mogelijkheden voor urinedeviatie.

ABSTRACT

OBJECTIVE: To analyse 48 urinary diversions in an oncological patient population. DESIGN: Retrospective study. SETTING: The Dutch cancer institute 'Nederlands Kanker Instituut/Antoni van Leeuwenhoek Ziekenhuis' in Amsterdam, the Netherlands. METHOD: The medical records of all patients who had a urinary diversion in the period 1989-1993 were analysed for type of diversion, indication for this specific type and postoperative complications. RESULTS: In 48 patients (24 women and 24 men with a mean age of 62.1 years) a urinary diversion was constructed because of cystectomy for bladder cancer (n = 27), cystectomy in total pelvic exenteration (13), total urinary incontinence following radiotherapy (5), urethral cancer (1) or local palliation (2). Twenty-one diversions according to Bricker, 25 continent reservoirs according to Rowland and (or) neo-bladders, I ureterosigmoidostomy and I continent access to the bladder (Mitrofanoff procedure) were done. The standard diversion according to Bricker was preferred in the following circumstances extensive intestinal resections (also previous ones), older age, fear of incontinence or no need for continent diversion. Specific problems of the new diversion techniques were difficulties of patients with catheterising the reservoir and folic acid deficiency. All other postoperative problems were related to the extensiveness of the primary oncological procedure rather than to the diversion technique. CONCLUSION: Apart from a few contraindications such as shortage of intestine, tumour growth into the urethra and patients' inability or unwillingness to catheterize themselves, there are no objections to the new diversion techniques (continent reservoir/neo-bladder). Patients being considered for urinary diversion ought to be informed about these new techniques.