Bladder replacement and urinary diversion

The use of orthotopic bladder substitution and urinary diversion has increa sed markedly over the last 15 years and this trend is expected to continue. Up to 50% of patients with invasive bladder cancer may be suitable candida tes for orthotopic reconstruction. Medium- and long-term follow-up data ind icate that the use of orthotopic bladder substitution can result in superio r quality of life for patients compared with other forms of urinary diversi on. Careful patient selection and vigilant follow-up are essential to maint ain these good results. The principal issues surrounding the practice of or thotopic bladder substitution and urinary diversion are discussed.