It has been used to divert urine in patients with benign bladder conditions (neurogenic bladder, refractory hematuria, and interstitial cystitis) without necessarily performing cystectomy at the same time. Commonly noted complications after the procedure include pyocystis, an unremitting sensation of pain, spasm and hemorrhage.

Recently, a retrospective study was published by T. Fazili and colleagues from Kent, United Kingdom, which followed the fate of bladders left in place after supravesical diversion for benign disease in 24 patients from 1996 to 2004. The manuscript is published in the August 2006 issue of the Journal of Urology.

The patient s undergoing urinary diversion had indications including incontinence, acontractile bladder, radiation and/or hemorrhagic cystitis, and neurogenic bladder. There were 9 males and 15 females with a mean age of 59 years in the study group. Median follow-up was 48 months.

Analysis of the results showed that 13 (54%) experienced problems with the retained bladder, 2(8%) presented with urethral bleeding, which resolved by conservative means, and 211 (46%) had infective complications, which resolved with expectant treatment in 3 (12%). Eight patients (33%) presented with pyocystis and 6 of these required eventual cystectomy.

This study shows that the morbidity related to the defunctionalized bladder can be considerable. One in 4 patients eventually needs a cystectomy. These findings are no different from those reported by others more than 30 years ago. Thirty years ago, however, a cystectomy was a much more morbid procedure. With advances in the surgical technique and improvements in anesthesia, it seems logical to perform primary cystectomy at the time of diversion to avoid the high morbidity associated with the defunctionalized bladder.

J Urol. 2006 Aug; 176(2):620-21

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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