CYSTECTOMY AND URINARY-DIVERSION

New insights into bladder cancer mechanisms have not yet produced clin ical benefit. Without novel treatments, cystectomy remains the most ef fective local treatment, albeit the most aggressive. Uncertainty about the natural history of bladder cancer, the progression rate after oth er treatments, the risks of cystectomy and subsequent quality of life, foster debate about the indications for cystectomy. There are numerou s urinary diversions and bladder substitutes, Differences in tumour ex tent, patient age, performance status, renal and mental function, and acceptance make different diversion techniques necessary. Urologists n eed not know every technique, but should know at least one technique o f each class: an incontinent diversion (such as the ileal conduit), ur eterosigmoidostomy, continent reservoir, and orthotopic bladder substi tute, The common principles, advantages, and contraindications of thes e techniques are discussed. (C) 1997 Wiley-Liss, Inc.