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Urinary Diversion: Core Curriculum 2021.

Colin D Sperling1, Daniel J Lee1, Sandeep Aggarwal2

  • 1Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|May 11, 2021
PubMed
Summary
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Urinary diversion after cystectomy offers various reconstructive options, including orthotopic neobladders and continent cutaneous diversions. Conduit diversion is a common, less morbid choice, requiring multidisciplinary care for metabolic complications.

Area of Science:

  • Urology
  • Nephrology
  • Surgical Oncology

Background:

  • Urinary diversion is a standard treatment for bladder diseases.
  • Surgical techniques and understanding of metabolic issues have improved outcomes.
  • Both continent and incontinent urinary diversions are available.

Purpose of the Study:

  • To outline aspects of urinary diversion after cystectomy.
  • To discuss reconstructive options and postoperative metabolic abnormalities.
  • To emphasize the need for a multidisciplinary approach.

Main Methods:

  • Review of historical and current urinary diversion techniques.
  • Discussion of patient selection for different diversion types.
  • Analysis of short-term and long-term metabolic sequelae.
Keywords:
Acid-base disordersbladder cancercystectomyelectrolyte homeostasismetabolic abnormalitiesmineral-bone diseaseneobladderrenal functionreviewurinary conduiturinary diversionurolithiasis

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Main Results:

  • Orthotopic neobladders and continent cutaneous diversions offer functional and body image benefits.
  • Conduit diversion is a less morbid option, avoiding self-catheterization.
  • Effective management requires collaboration between nephrology and urology.

Conclusions:

  • Various urinary diversion techniques exist, each with specific patient benefits.
  • Postoperative metabolic and acid-base homeostasis requires careful monitoring.
  • A multidisciplinary approach is crucial for optimizing patient outcomes after cystectomy and urinary diversion.