ABSTRACT
Ever since Bardenheuer of Cologne performed the first cystectomy for a tumor of the bladder in 1887,1 the surgical challenge has not been to remove the diseased organ but to replace its function appropriately: the first patient died 14 days after his ureters were left to drain the urine into the pelvis. More than a hundred years later, the optimal form of urinary diversion after cystectomy for muscle invasive bladder cancer remains a highly controversial issue. Some authors suggest that orthotopic bladder substitution allows a quality of life similar to that of individuals with a native lower urinary tract.2 In fact, a recent study comparing recurrence-free Danish patients after orthotopic reconstruction with a frequency matched control population in the same geographical region using a non-established questionnaire found similar wellbeing and subjective quality of life in both groups.3 In a Cochrane review,4 however, an evidencebased approach to determine the best way of improving or replacing the function of the lower urinary tract using intestinal segments did not find any evidence that continent diversion was better than conduit diversion, or vice versa. The authors were also critical about the absence of good quality data in the literature despite the fact that such surgery has been commonplace for so many years.
