Urinary Diversion Methods

Types of Urinary Diversions

The National Comprehensive Cancer Network recommends the ileal conduit as the most common urinary diversion method, where a segment of ileum is isolated to create a conduit between ureters and the abdominal wall, requiring an external collection appliance 1
Ureters can be implanted directly into the sigmoid colon using ureterosigmoidostomy, allowing for continence but requiring regular monitoring due to high cancer risk, as recommended by the Gut journal 2, 3

Patients must be thoroughly educated about their urinary diversion options before surgery, as recommended by the National Comprehensive Cancer Network 1
Meeting with an enterostomal therapist is essential for patients considering an ileal conduit to mark optimal stoma site, according to the National Comprehensive Cancer Network 1
Manual dexterity assessment is crucial for patients considering continent catheterizable diversions to ensure ability to self-catheterize, as recommended by the National Comprehensive Cancer Network 1

Annual flexible sigmoidoscopy is mandatory beginning 10 years after ureterosigmoidostomy surgery due to significantly increased cancer risk, as reported in the Gut journal 2, 3
Neoplasia risk at ureterocolonic anastomosis is estimated at 1,726 times that of normal population, according to the Gut journal 4
Even patients who later convert to different diversion methods require continued surveillance unless the anastomosis was completely removed, as recommended by the Gut journal 3, 5

Appropriate perioperative antibiotics are essential, with second or third-generation cephalosporins recommended, as suggested by the National Comprehensive Cancer Network 1
Deep vein thrombosis prophylaxis is critical due to high risk in this population, according to the National Comprehensive Cancer Network 1
Ureterosigmoidostomy carries significant risk of adenoma/adenocarcinoma development, as reported in the Gut journal 2, 3
For patients with persistent incontinence after prostatectomy, urinary diversion may be considered when other options fail, as recommended by Praxis Medical Insights 6

Polypoid lesions at ureterosigmoidostomy anastomoses should not be removed with endoscopic snare due to risk of urinary leakage, as reported in the Gut journal 3
The neoplastic process in ureterosigmoidostomy begins early and continues even if diversion is changed but anastomosis remains, according to the Gut journal 5

The American College of Surgeons and National Comprehensive Cancer Network recommend the ileal conduit as the standard and preferred urinary diversion method after radical cystectomy, offering the fastest operative time, lowest complication rates, and most reliable long-term outcomes, particularly for elderly patients and those with comorbidities 7
Preoperative stoma marking by an enterostomal therapist is essential to optimize stoma site and reduce postoperative complications, as recommended by the European Association of Urology 8

Ureteral stenting at the time of surgery improves upper tract drainage, enhances bowel recovery, and reduces metabolic acidosis, according to the Clinical Nutrition guidelines 9, 10

The use of colonic conduits is rarely indicated and should only be considered when the ileum is unavailable or unsuitable, due to higher metabolic complications and increased risk of electrolyte abnormalities, as noted in the Clinical Nutrition journal 9, 10

The refluxing anastomosis is the standard approach, as it is simpler and faster to perform technically, with lower stricture rates, and easier to revise if complications occur, according to the Journal of the National Comprehensive Cancer Network 7
Anti-refluxing anastomosis may prevent reflux of urine and bacteria to upper tracts theoretically, but it has significantly higher stricture rates and is more technically demanding, with no proven clinical benefit, as noted in the Clinical Nutrition journal 9, 10