الفهرس | Only 14 pages are availabe for public view |
Abstract Introduction: Radical cystectomy remains the most effective local treatment for invasive bladder cancer. While new insights into bladder cancer mechanisms have produced little clinical progress from an oncological point of view, the last 2 decades have seen an unprecedented development of techniques for reconstructing the lower urinary tract aimed at maintaining control of urine storage and emptying. Aim of the work: The aim is to evaluate different types of continent urinary diversion after radical cystectomy and evaluate the effects of continent urinary diversion after radical cystectomy on quality of life. Conclusion: An orthotopic bladder substitution should be the first choice of urinary diversion whenever the urethra can be spared safely, without compromising the oncological aim of the procedure with respect to the patient’s general condition. Refinements of surgical techniques such as autonomic nerve preservation and improved afferent (ureteral) and efferent (urethral) anastomoses result in excellent functional outcomes and improved quality of life. A simple end-to-side freely refluxing anastomosis to an afferent limb of a low-pressure orthotopic reconstruction, in combination with regular voiding and close follow-up, is the procedure with the lowest overall complication rate. |