ABSTRACT
Radical cystectomy continues to be performed for muscle invasive bladder cancer, superficial bladder cancer refractory to conservative measures, other pelvic malignancies requiring exenteration, and benign conditions resulting in what has been variously termed an ‘endstage bladder’. Currently, the spectrum of urinary diversions available to patients includes conduits of small and large bowel, continent cutaneous reservoirs, and orthotopic bladder substitution. Advantages of orthotopic neobladder reconstruction include the elimination of a cutaneous stoma or collection device, as well as the ability to preserve a near-normal volitional voiding pattern that allows patients to consciously void per the urethra at socially convenient intervals. These advances have been made in an effort to improve patients’ lifestyle and self image following radical cystectomy. Indeed, Hobisch et al, using a validated quality of life questionnaire, found that patients with an orthotopic neobladder were more able to adapt to their new situation than patients with an ileal conduit, and that 97% of neobladder patients would recommend the same urinary diversion to a friend, compared with 36% of ileal conduit patients,1 although a separate study found no differences in quality of life between patients with continent and conduit urinary diversions.2
