ABSTRACT
Since the major publications by Bors,1 Comarr,2 Guttmann3 and others in the 1950s our understanding of and approach to managment of patients with neurogenic voiding dysfunction have evolved significantly. The management goals for these patients involve low-pressure storage, near complete bladder emptying at low voiding pressure, avoiding incontinence and protecting the upper urinary tract to preserve renal function. Since all these goals can be achieved by conservative treatment, this has become the mainstay of urologic management. Urologic complications accounted for the death of 30-50% of patients who sustained spinal cord injury during the Second World War4. In patients who could not be managed with indwelling catheterization, urinary diversion with ileal conduit was proposed and popularized by Bricker in 1952.5 However, the long-term follow-up of ileal conduit diversion shows upper tract deterioration in 30-48% of patients and the need for reoperation in 32-60% of patients.6-8 The introduction of clean intermittent self-catheterization (CISC) by Lapides and associates in 1972 revolutionized the management of neurogenic bladder.9 By the end of the 1970s, there were very few indications for urinary diversion.10 Urinary diversion is a viable option for patients who cannot be maintained on an effective conservative management program. A number of urinary diversion procedures are currently available and they continue to evolve. All options should be discussed with the patient and tailored to each individual patient’s neuro-urologic status.
