URINARY-DIVERSION - SHOULD THE DECISION W HETHER TO OPERATE BE MADE ON A CASE-BY-CASE BASIS - INDICATIONS AND OUTCOME IN 200 CONSECUTIVE PATIENTS

During the past 20 years many continent urinary diversions have been e stablished. The indications includes pelvic tumors, especially bladder cancer, and structural and functional disorders of the lower urinary tract with irreversible damage of storage or continence function. Give n the variety of surgical diversion techniques, it seems feasible to c onsider the patient's individual pathoanatomical situation as well as his/her personal wishes. We report on 200 consecutive patients with su pravesical urinary diversion. The analysis includes indications surgic al technique, intra- and postoperative complications and patients' qua lity of life. The peri- and postoperative morbidity rate was 18.5 %. C omplications mainly comprised infections and obstruction of the urinar y tract. The mortality rate was 4.5 % and causes of death included ble eding, infection, urinary extravasation and bowel atonia. Patients wit h malignant disease and only palliative treatment showed disappointing results after on operation including continent urinary diversion: 30 % of them had early complications. Several female patients with a cath erizable continent urinary diversion could not handle the catheterizat ion of the pouch, although the function of the urinary diversion was e xcellent. Therefore an indwelling catheter was placed in all these pat ients. Our analysis shows that the choice of urinary diversion has to consider the patient's pathoanatomical situation, as well as his/her a ge, general condition, mental and manual skills. In addition, renal fu nction, the metabolic situation and previous therapies may influence t he decision regarding supravesical urinary diversion in an individual case.