Indications for Diversion of the Urinary Stream

Diversion of the urinary stream is required when the bladder has to be removed, usually for cancer, or is unable to function as an adequate urinary reservoir. The lesions which call for diversion fall into three categories:

1. Malignant Disease.—Total cystectomy for bladder cancer necessitates urinary diversion. Diversion may also prove a useful palliative for patients with advanced inoperable bladder cancer suffering intolerable frequency and strangury. Other indications are as follows: when cystectomy is needed because of severe and persistent bladder hemorrhage after x-ray therapy and when uncontrollable irradiation cystitis follows x-ray therapy to the uterine cervix, for carcinoma of the female urethra prior to irradiation or surgical extirpation, as a palliative for malignant rectovesicovaginal fistula, and for ureteric obstruction due to pelvic malignancy

2. Congenital Anomalies.—Ectopic vesicae continue to be dominant indications for urinary diversion, as plastic procedures have so far yielded only minimum success in providing