요로전환술: 회장도관에서 정위성 인공방광대치술까지

During the last decade, urinary diversion has evolved from simply diverting the urine through a conduit to continent urinary diversion, especially orthotopic bladder substitution. At present, all the patients undergoing cystectomy are neobladder candidates. In general, if sphincter sparing surgery is possible, then orthotopic bladder substitution is performed; if this can`t be done, then continent catheterizable reservoirs or noncontinent cutaneous diversion are viable options. The rate of complications of neobladders is actually similar to the true complication rates after conduit formation, which is in contrast to the popular view that conduits are simple and safe. The need for reflux prevention is not the same as for creating a ureterosigmoidostomy conduit or continent diversion. Reflux prevention in neobladders is even less important than in a normal bladder. When using nonrefluxing techniques, the risk of obstruction is at least twice that after direct anastomosis. Strict patient selection criteria and improved surgical technique have had a positive influence on the outcome, not only on survival but also on quality of life issues. Until a better solution is devised, orthotopic bladder reconstruction remains the best option for patients requiring cystectomy.