Urinary Diversion

In the last three decades, CIC proposed by Lapides has been accepted in the urologic community as an excellent method of management of the bladder that fails to empty. However, this option may not be applicable for some people, such as those without manual dexterity and limited assistance from caretakers. In these cases, options may include the use of chronic indwelling urethral or suprapu-bic catheter or urinary diversion. Chronic catheter placement is frequently associated with complications including stone formation, tissue erosion, frequent infection, and malignancy; therefore, it is uncommonly used as the firstline management. As discussed in a previous chapter, urinary diversion, which traditionally takes the form of ileal conduit involving ureteral reimplantation may lessen the risk for chronic catheter-associated problems. However, a different set of problems such as urinary reflux and ureteral obstruction may arise that are best avoided by performing urinary diversions that incorporate the native bladder and preserve the bladder trigone for drainage of the upper urinary tract.

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