Although the procedure requires special skills and increases the length of the operation, all appropriate candidates should be offered this form of diversion. Some continent diversions have a small stoma on the abdominal wall. The urine is drained 4 to 6 times daily by placing a catheter through the soma into a urinary reservoir made of bowel. The stoma which is flush with the skin is easily concealed with a gauze sponge. Other forms of continent urinary diversion have a urinary reservoir attached to the urethra and the patient voids normally through the penis.
Proper selection is crucial to avoid reoperation.
This includes documentation that high grade or invasive disease is not present in the bladder neck or prostatic urethra. Unfortunately, most of these types of bladder substitutions have been used only in men because continence cannot be maintained in women. Ongoing studies may better tell physicians the optimal timing of chemotherapy. Some physicians feel that bladder removal should be performed prior to systemic chemotherapy since some surgically resectable tumors may progress and become impossible to surgically remove while on chemotherapy, cancer volume may be reduced by surgery so the chemotherapy has less cancer cells to kill, and by pathologically examining the surgical specimen the need for systemic chemotherapy is more precisely assessed.