Palliative urinary diversion

With the development of nonsurgical methods of urinary diversion and the availability of new and more effective methods for treating cancer, an increasing number of patients will be candidates for palliative urinary diversion. Urinary diversion is clearly indicated to provide the time necessary to establish the correct diagnosis, to treat pain or sepsis, and to provide time for other treatments to control the underlying disease. When diversion is being considered solely for the purpose of treating uremia and the tumor has proved to be refractory to all known effective forms of treatment, the decision about whether to perform a diversion must be based on the individual circumstances of the patient including the age, type of tumor, and social and economic considerations. Methods of internal diversion such as ureteral stents are preferred when feasible. Percutaneous nephrectomy may be useful when internal diversion cannot be accomplished or when it can be anticipated that the diversion will be only temporary. When permanent diversion is required, loop cutaneous ureterostomy using the better kidney or bilateral cutaneous ureterostomy is effective only when the ureters are dilated. Diversion into an ileal segment is necessary when the ureters are of normal caliber.