Continent urinary diversion and bladder substitution

Various forms of supravesical urinary diversion and bladder substitution are currently available. Several factors are considered when deciding which procedure to perform. These include the patient's medical and psychological condition, needs and preferences as well as the surgeon's experience and preferences. While ureterosigmoidostomy is seldom utilized today, it still has a place in properly selected patients with limited life expectancy. Standard ileal conduit remains a reasonable choice in some patients who do not wish or are not suitable candidates for continent forms of diversion. Continent urinary diversion and bladder substitution are attractive choices for most patients needing supravesical urinary diversion. We have found the Charleston pouch to be the ideal form of continent urinary diversion. While continent urinary diversion and bladder substitution improve the quality of life and are well accepted by patients and their urologists, potential complications must be recognized. Long-term follow-up is essential. Finally, patients who have had definitive diversion, such as ileal or colon conduit may now be considered for undiversion or for conversion to continent urinary diversion.