Urinary diversions: advantages and disadvantages of the major types of diversions

There is an ongoing debate concerning the optimal choice of urinary diversion following bladder extirpative surgery. Among others, several factors including patient preferences, age, sex and baseline renal function play an important role in the ultimate decision. This review describes the major types of urinary diversions performed, outlining the advantages and disadvantages of each.

There continues to be an underutilization of continent diversions despite their recent popularization. However, recent evidence suggests their increased use, particularly at academic centers. Patient factors and surgeon preference finally dictate the choice of diversion. It is still unclear whether outcomes are superior with one type of diversion over another.

Various types of diversions continue to be performed throughout the world following radical cystectomy. Future prospective randomized trials comparing different diversions can help counsel patients. Regardless of type of diversion, patients will require life-long postoperative care.