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See also: Neobladders For Women
The ileal conduit remains the standard for urinary diversion after cystectomy in the elderly and in persons with advanced cancers or other medical complications which would preclude long surgical procedures; this surgery is usually less than 4 hours.
Two main alternatives to the ileal conduit have become steadily more
available: the catheterizable (through an abdominal stoma)
continent reservoir (internal pouch)
such as the Indiana or Mainz pouch, and the orthortopic
neobladder such as the Studer or Kock neobladder.
As with the creation of a continent rerservoir (internal pouch), this operation requires skill and experience on the part of the surgical team. The patient must also be in relative good health and able to withstand the longer operation and recovery period.
The neobladder allows select patients to void naturally through the urethra.
The neobladder, also known as 'continent orthotopic urinary reconstruction',
appeals especially to younger patients who wish to avoid a stoma on the
abdomen and/or wearing an ostomy bag. In many cases those with neobladders
learn how to completely empty their bladders and do not require intermittent
catheterization. However, this is a learned response and not a guarantee.
In cases where 100% continence is not realized, regular or intermittent
self-catheterization may be necessary.
Key points in postoperative management include:
See also: First hand experiences-Tales
From the Trenches: