Ileal Conduit as the Standard for Urinary Diversion After Radical Cystectomy for Bladder Cancer

For >30 yr, the ileal conduit (IC) has been considered the standard urinary diversion for bladder cancer patients submitted to radical cystectomy. It is universally recognised as being the most clinically adequate, cost-effective, and reliable solution in the long term. During the last two decades, this surgical procedure has been challenged by the dissemination and the excellent clinical outcome of bladder substitutions, which gave the surgeon options in supporting the patient's final choice. Despite this, from a survey of recent literature, IC remains a widely used urinary diversion in most urologic centres. In particular, it is most frequent in female patients and in patients >70 yr with high preoperative comorbidities and unfavourable clinical tumour stage. Enhanced recovery protocols with standardised perioperative plans of care or fast-track approaches as well as advances in postoperative patient surveillance have consistently decreased the overall morbidity related to the IC procedure. Although technically simpler to perform when compared with continent reservoirs, IC has not been associated with lower complications. This can be explained partly by the more unfavourable clinical characteristics of patients who undergo the procedure and partly by technical surgical errors. Postoperative complications strictly related to IC contribute to reduce the postoperative quality of life. These complications include uretero-ileal anastomotic strictures and stomal, peristomal, and abdominal wall-related complications. Most prospective studies, however, found no difference in overall quality of life when comparing different types of transposed intestinal segment surgery. (C) 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.