Modification of the surgical technique in radical cystectomy

Traditional teaching has held that urinary diversion should be performed following cystectomy in the treatment of muscle invasive bladder cancer. We have found that performing the diversion prior to removal of the bladder is an acceptable modification of the standard radical cystectomy. The advantages of performing the diversion first include having a fresh operative team to perform the most technically challenging portion of the procedure, avoidance of blood loss until later in the case, and the ability to mature the stoma during abdominal wall closure.