Urinary diversion

Abstract

Introduction The goals of urologic management of neurogenic bladder dysfunction are to achieve and maintain low-pressure urinary storage and voiding, with preservation of the upper urinary tract and achievement of urinary continence. Long-term management has been facilitated by the widespread acceptance of clean self-intermittent catheterization (CIC).1 The introduction of new medications over the past few years has also contributed to management. The vast majority of patients with neurogenic bladder dysfunction can be managed without resorting to urinary diversion. However, there continues to be patients who are unwilling or unable to perform self-catheterization or to be intermittently catheterized. There are others who, despite appropriate management, are unable to maintain low-pressure urinary storage and voiding and/or continence. It is these patients who may benefit from lower urinary tract reconstruction and urinary diversion rather than resort to indwelling Foley catheters.