الفهرس 
Indications of urinary diversionOnly 14 pages are availabe for public view
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Abstract
Bladder substitution is the optimal management of muscle invasive bladder cancer as well as some benign pathology affecting the bladder and / or the urethra after failure of other conservative or reconstructive measures. The primary objective of bladder substitution is to improve the quality of life and to offer the patient a satisfactory functional outcome. One of the most important outcomes is preservation of the upper tract. Each type of diversion has its own set of individual complications. The knowledge of the frequency of these complications and the correct performance of preoperative preparation, surgical technique, and postoperative care, should provide the best chance for the least mortality and morbidity in patients undergoing urinary intestinal diversion. The main factors contributing to deterioration of the upper tract after urinary diversion is refluxing pyelonephritis and uretero-intestinal anastomotic stricture. Although refluxing pyeloneohritis seems to be of minor significance in intestinal conduits being non continent, it has major rule in orthotopic substitution and continent cutaneous diversion necessitating providence of antireflux mechanism for ureterointestinal anastomosis whenever possible. Although many patients with preexisting dilation of the upper tract show improvement or resolution of dilation after urinary diversion, progressive renal deterioration is usually manifested by hydronephrosis or decrease of the glomrular filtration rate (or both). The first line for management of uretero-intestinal anastomotic stricture is via the endoscopic approach which provides success in about half of cases. If failed, open revision is then the appropriate management. The increased metabolic burden on the kidneys seems to be inevitable in all types of urinary diversion owing to solutes and electrolytes absorption. However its effect can be minimized by regular voiding and, in some cases clean intermittent catheterization (CIC).