Two types of urinary diversion after total cystectomy

Total cystectomy for bladder cancer involves a wide range of resection. Urinary diversion is required after surgery to solve the patient's urination problem. Urinary diversion can be roughly divided into the following two types:

1. Incontinence urinary diversion

Uncontrollable urinary diversion refers to a direct stoma of the ureter in the abdominal wall or a stoma of the ureter connected to a section of the intestine and then to the abdominal wall. The involuntary urine is collected in a urine collection bag by wearing a urine collection bag. The advantage is that this procedure is relatively less traumatic in urinary diversion. The main disadvantage is that an abdominal stoma is required, and a urine collection bag must be worn for life. In addition, the skin around the stoma is prone to complications such as inflammation and ulcers. Uncontrollable urinary diversion mainly includes ureterostomy and ileal bladder surgery.

2. Controlled urinary diversion

Controlled urinary diversion mainly includes two procedures: establishing a controlled urinary sac and using the anus to control urine. The procedure of establishing a controlled urinary sac refers to using a section of intestine to make a sac-like urinary sac and a one-way "valve" abdominal wall stoma, and the urine is discharged through timed self-catheterization. Controlled urinary sac is suitable for patients with a long life expectancy, who can tolerate complex surgery, have good bilateral kidney function, can ensure electrolyte balance and waste excretion, have no upper urinary tract infection, have no intestinal lesions, and can self-catheterize. Establishing a controlled urinary sac is a commonly used controlled urinary diversion procedure. The procedure of using the anus to control urine requires that the patient's anal sphincter function must be good, including urine-fecal diversion and urine-fecal diversion. This procedure is rarely used in clinical practice due to its many complications.