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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Urinary Diversion
Urology, Volume 69, No. 1 SUPPL., Year 2007
Notification
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Description
A consensus conference convened by the World Health Organization (WHO) and the Société Internationale d'Urologie (SIU) met to critically review reports of urinary diversion. The world literature on urinary diversion was identified through a Medline search. Evidence-based recommendations for urinary diversion were prepared with reference to a 4-point scale. Many level 3 and 4 citations, but very few level 2 and no level 1, were noted. This outcome supported the clinical practice pattern. Findings of >300 reviewed citations are summarized. Published reports on urinary diversion rely heavily on expert opinion and single-institution retrospective case series: (1) The frequency distribution of urinary diversions performed by the authors of this report in >7000 patients with cystectomy reflects the current status of urinary diversion after cystectomy for bladder cancer: neobladder, 47%; conduit, 33%; anal diversion, 10%; continent cutaneous diversion, 8%; incontinent cutaneous diversion, 2%; and others, 0.1%. (2) No randomized controlled studies have investigated quality of life (QOL) after radical cystectomy. Such studies are desirable but are probably difficult to conduct. Published evidence does not support an advantage of one type of reconstruction over the others with regard to QOL. An important proposed reason for this is that patients are subjected preoperatively to method-to-patient matching, and thus are prepared for disadvantages associated with different methods. (3) Simple end-to-side, freely refluxing ureterointestinal anastomosis to an afferent limb of a low-pressure orthotopic reconstruction, in combination with regular voiding and close follow-up, is the procedure that results in the lowest overall complication rate. The potential benefit of "conventional" antireflux procedures in combination with orthotopic reconstruction seems outweighed by the higher complication and reoperation rates. The need to prevent reflux in a continent cutaneous reservoir is not significantly debated, and this should be done. (4) Most reconstructive surgeons have abandoned the continent Kock ileal reservoir largely because of the significant complication rate associated with the intussuscepted nipple valve. © 2007 Elsevier Inc. All rights reserved.
Authors & Co-Authors
Hautmann, Richard E.
Germany, Ulm
Universität Ulm
Abol-Enein, Hassan A.
Egypt, Mansoura
Mansoura University, Urology and Nephrology Center
Hafez, Khaled S.
United States, Ann Arbor
University of Michigan, Ann Arbor
Haro, Isao
Japan, Kobe
Kobe University School of Medicine
Mânsson, Wiking
Sweden, Lund
Skånes Universitetssjukhus
Mills, Robert D.
United Kingdom, Norwich
Norfolk and Norwich University Hospitals Nhs Foundation Trust
Montie, James E.
United States, Ann Arbor
University of Michigan, Ann Arbor
Sagalowsky, Arthur I.
United States, Dallas
Ut Southwestern Medical Center
Stein, John Peter
United States, Los Angeles
University of Southern California
Stenzl, Arnulf
Germany, Tubingen
Eberhard Karls Universität Tübingen
Studer, Urs E.
Switzerland, Bern
University of Bern
Volkmer, Bjöern G.
Germany, Ulm
Universität Ulm
Statistics
Citations: 221
Authors: 12
Affiliations: 10
Identifiers
Doi:
10.1016/j.urology.2006.09.069
ISSN:
00904295
e-ISSN:
15279995
Research Areas
Cancer
Disability
Health System And Policy
Study Design
Cohort Study
Case-Control Study