Approach to urinary diversion in the surgical patient

Major surgical procedures may remove part or all of the bladder and make an incontinent or continent urinary diversion appropriate. Preoperative consi deration must be given to 1) the stoma and its position, 2) the catheteriza ble channel, 3) the urinary continence mechanism, and 4) the substitute bla dder reservoir. Complete bowel preparation and broad-spectrum antibiotics a re desirable. The patient's motivation for taking care of a continent urina ry diversion is important, since lifelong catheterization and mucous irriga tion may be necessary. The status of the native bladder outlet and urinary sphincter is important in cases in which an orthotopic continent urinary di version is considered. Preoperative evaluation by a stoma therapist is inva luable. Adequate urinary drainage is important in the immediate postoperati ve period. Patients with urinary diversions must be followed lifelong to ru le out asymptomatic deterioration of their upper urinary tracts and to chec k for potential metabolic and nutritional problems. J. Surg. Oncol. 2000;73 :33-38. (C) 2000 Wiley-Liss, Inc.