期刊
CURRENT OPINION IN UROLOGY
卷 30, 期 3, 页码 415-420出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MOU.0000000000000738
关键词
ileal conduit; orthotopic neobladder; outcomes; quality of life
资金
- Sidney Kimmel Center for Prostate and Urologic Cancers
- National Institutes of Health/National Cancer Institute Cancer Center Support Grant [P30 CA008748]
- National Institutes of Health T32 Ruth L. Kirschstein Institutional National Research Service Award
Purpose of review The orthotopic neobladder and ileal conduit are the two most commonly utilized urinary diversions among patients undergoing radical cystectomy. Although orthotopic diversion offers several advantages, only 20% of patients nationally receive this diversion, with decreasing utilization over time. The purpose of this article is to review advantages of each diversion type and considerations in patient selection, review trends in diversion utilization and perioperative and functional outcomes, and examine recent studies evaluating methods of optimizing diversion selection and patient satisfaction and outcomes. Recent findings Decreasing utilization of orthotopic diversion has coincided with the increasing utilization of minimally invasive surgical techniques. A multicentre robotic series demonstrated a higher incidence of high-grade complications with intracorporeal diversion, reflecting the learning-curve associated with this technique. Patient satisfaction with urinary diversion is associated with informed decision-making and goal alignment. Ongoing quality of life studies is aiming to identify predictors of patient satisfaction with the selected urinary diversion and may help guide patient counselling. Summary Given the potential advantages of orthotopic diversion, its decreasing use is a concerning trend. Elucidating patient goals and informed decision-making are critical to patient satisfaction. A patient-centred approach should be used when selecting the type of urinary diversion for a given patient.
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