Quality of life following incontinent cutaneous and orthotopic urinary diversions

The quality of life (QOL) of patients requiring urinary diversion remains an important issue within the field of Urology. The majority of this population has undergone cystectomy as treatment for malignant disease. In the initial phases of treatment counseling, the patient is focused on the eradication of their tumor. However, it is the urinary diversion that will have a lasting functional impact on the patient every day for the rest of their lives. The selection of an appropriate diversion, then, is critical to long-term satisfaction with the surgical treatment. Patients must be fully counseled in all types of urinary diversion and should have ready access to all options. Reported differences in QOL between diversion populations are difficult to interpret in view of limitations in the methodology of study designs and apparent selection bias. Ultimately, as a community, urologists cannot definitively say that one class of urinary diversion is superior to another. Instead, we must empower the patient in their own decision making with an accurate impression of diversion recovery, required education and training, and related side-effects and complications. The choice of urinary diversion still remains a very personal decision to be made between the patient, family members, friends, and the physician.