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  • Review Article
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Complications associated with urinary diversion

Nature Reviews Urology volume 8, pages 667–677 (2011)Cite this article

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Abstract

Radical cystectomy (RC) with subsequent urinary diversion has been assessed to be the most difficult surgical procedure in the field of urology. No randomized trials have been performed to compare the outcomes of noncontinent conduit diversion, neobladder construction and continent cutaneous diversion. Almost all studies are of level 3 evidence, meaning the recommendations given in this Review are of grade C only. Until recently, significant disparity in the quality of surgical complication reporting, as well as the lack of universally accepted reporting guidelines, definitions and grading systems, have made it impossible to compare the surgical morbidity and outcomes of RC. There is a clear case for the standardized reporting of complications. The Clavien system is a straightforward and validated instrument that has already been successfully adopted by several urological centers. Surgical morbidity following RC is significant and, when strict reporting guidelines are incorporated, much higher than previously published. Complications can occur up to 20 years after surgery, emphasizing the need for more long-term studies to determine the full morbidity spectrum. In general, renal function after construction of continent detubularized reservoirs compares favorably with ileal conduit diversion, although the literature is insufficient to recommend one over the other. The challenge of optimum care for elderly patients with comorbidities is best mastered at a high-volume hospital by a high-volume surgeon.

Key Points

  • Radical cystectomy (RC) and subsequent urinary diversion has been assessed to be the most difficult surgical procedure in the field of urology

  • No randomized trials have been performed to compare the outcomes of noncontinent conduit diversion, neobladder construction and continent cutaneous diversion

  • Significant disparity in the quality of surgical complication reporting has made it impossible to compare surgical morbidity in patients who have undergone RC; there is a clear case for the standardized reporting of complications

  • Overall, the perioperative surgical morbidity following RC and urinary diversion is significant and, when strict reporting guidelines are incorporated, much higher than previously published

  • Complications can occur up to 20 years after surgery, emphasizing the need for close monitoring of these patients and more long-term studies to determine the full morbidity spectrum

  • Evidence suggests an association between volume and outcome in cystectomy procedures; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons

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References

  1. Montie, J. E. in Textbook of Operative Urology (ed. Marshall, F. F.) 396–407 (Saunders, Philadelphia, 1996).

    Google Scholar 

  2. Hautmann, R. E. et al. in Bladder Cancer (eds Soloway, M., Abrams, P. & Khoury, S.) in press (Health Publication Ltd, Paris, 2011).

    Google Scholar 

  3. Hautmann, R. E., de Petriconi R. C. & Volkmer, B. G. Lessons learned from 1,000 neobladders: the 90-day complication rate. J. Urol. 184, 990–994 (2010).

    Article  PubMed  Google Scholar 

  4. Madersbacher, S. et al. Long-term outcome of ileal conduit diversion. J. Urol. 169, 985–990 (2003).

    Article  PubMed  Google Scholar 

  5. Shimko, M. S. et al. Long-term complications of conduit urinary diversion. J. Urol. 185, 562–567 (2011).

    Article  PubMed  Google Scholar 

  6. Froehner, M., Brausi, M. A., Herr, H. W., Muto, G. & Studer, U. E. Complications following radical cystectomy for bladder cancer in the elderly. Eur. Urol. 56, 443–454 (2009).

    Article  PubMed  Google Scholar 

  7. Konety B. R., Allareddy, V. & Herr, H. Complications after radical cystectomy: analysis of population-based data. Urology 68, 58–64 (2006).

    Article  PubMed  Google Scholar 

  8. Chang, S. S., Cookson, M. S., Baumgartner, R. G., Wells, N. & Smith, J. A. Jr . Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J. Urol. 167, 2012–2016 (2002).

    Article  PubMed  Google Scholar 

  9. Cookson, M. S., Chang, S. S., Wells, N., Parekh, D. J. & Smith, J. A. Jr . Complications of radical cystectomy for nonmuscle invasive disease: comparison with muscle invasive disease. J. Urol. 169, 101–104 (2003).

    Article  PubMed  Google Scholar 

  10. Frazier, H. A., Robertson, J. E. & Paulson, D. F. Complications of radical cystectomy and urinary diversion: a retrospective review of 675 cases in 2 decades. J. Urol. 148, 1401–1405 (1992).

    Article  CAS  PubMed  Google Scholar 

  11. Ghoneim, M. A., el-Mekresh, M. M., el-Baz, M. A., el-Attar, I. A. & Ashamallah, A. Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 1,026 cases. J. Urol. 158, 393–399 (1997).

    Article  CAS  PubMed  Google Scholar 

  12. Hollenbeck, B. K. et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. J. Urol. 174, 1231–1237 (2005).

    Article  PubMed  Google Scholar 

  13. Joniau, S. et al. Clinical experience with the N-shaped ileal neobladder: assessment of complications, voiding patterns, and quality of life in our series of 58 patients. Eur. Urol. 47, 666–673 (2005).

    Article  CAS  PubMed  Google Scholar 

  14. Meller, A. E., Nesrallah, L. J., Dall'Oglio, M. F. & Srougi, M. Complications in radical cystectomy performed at a teaching hospital. Int. Braz. J. Urol. 28, 522–525 (2002).

    PubMed  Google Scholar 

  15. Meyer, J. P. et al. A three-centre experience of orthotopic neobladder reconstruction after radical cystectomy: initial results. BJU Int. 94, 1317–1321 (2004).

    Article  PubMed  Google Scholar 

  16. Quek, M. L. et al. A critical analysis of perioperative mortality from radical cystectomy. J. Urol. 175, 886–890 (2006).

    Article  PubMed  Google Scholar 

  17. Breau, R. H. et al. Reporting of harm in randomized controlled trials published in the urological literature. J. Urol. 183, 1693–1697 (2010).

    Article  PubMed  Google Scholar 

  18. Hautmann, R. E. et al. Urinary diversion. Urology 69 (Suppl. 1), 17–49 (2007).

    Article  PubMed  Google Scholar 

  19. Gore, J. L. & Litwin, M. S. Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J. Urol. 27, 45–50 (2009).

    Article  PubMed  Google Scholar 

  20. Donat, S. M. Standards for surgical complication reporting in urologic oncology: time for a change. Urology 69, 221–225 (2007).

    Article  PubMed  Google Scholar 

  21. Shabsigh, A. et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur. Urol. 55, 164–174 (2009).

    Article  PubMed  Google Scholar 

  22. Hautmann, R. E., de Petriconi R. C. & Volkmer, B. G. Lessons learned from 1,000 neobladders: the 90-day complication rate. J. Urol. 184, 990–994 (2010).

    Article  PubMed  Google Scholar 

  23. Morgan, M., Smith, N., Thomas, K. & Murphy, D. G. Is Clavien the new standard for reporting urological complications? BJU Int. 104, 434–436 (2009).

    Article  PubMed  Google Scholar 

  24. Dindo, D., Demartines, N. & Clavien, P. A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 240, 205–213 (2004).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Stolzenburg, J. U. et al. Categorisation of complications of endoscopic extraperitoneal and laparoscopic transperitoneal radical prostatectomy. World J. Urol. 24, 88–93 (2006).

    Article  PubMed  Google Scholar 

  26. Constantinides, C. A. et al. Short- and long-term complications of open radical prostatectomy according to the Clavien classification system. BJU Int. 103, 336–340 (2009).

    Article  PubMed  Google Scholar 

  27. Murphy, D. G., Kerger, M., Crowe, H., Peters, J. S. & Costello, A. J. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur. Urol. 55, 1358–1366 (2009).

    Article  PubMed  Google Scholar 

  28. Hayn, M. H., Hellenthal, N. J., Hussain, A., Stegemann, A. P. & Guro, K. A. Defining morbidity of robot-assisted radical cystectomy using a standardized reporting methodology. Eur. Urol. 59, 213–218 (2011).

    Article  PubMed  Google Scholar 

  29. Gore, J. L. et al. Urinary diversion and morbidity after radical cystectomy for bladder cancer. Cancer 116, 331–339 (2010).

    Article  PubMed  Google Scholar 

  30. Lawrentschuk, N. et al. Prevention and management of complications following radical cystectomy for bladder cancer. Eur. Urol. 57, 983–1001 (2010).

    Article  PubMed  Google Scholar 

  31. Williams, O., Vereb, M. J. & Libertino, J. A. Noncontient urinary diversion. Urol. Clin. North Am. 24, 735–744 (1997).

    Article  CAS  PubMed  Google Scholar 

  32. Pernet, F. P. P. M. & Jonas, U. Ileal conduit urinary diversion: Early and late results of 132 cases in a 25-year period. World J. Urol. 3, 140–144 (1985).

    Article  Google Scholar 

  33. Killeen, K. P. & Libertino, J. A. Management of bowel and urinary tract complications after urinary diversion. Urol. Clin. North Am. 15, 183–194 (1988).

    CAS  PubMed  Google Scholar 

  34. Neal, D. E. Complications of ileal conduit diversion in adults with cancer followed up for at least five years. Br. Med. J. 290, 1695–1697 (1985).

    Article  CAS  Google Scholar 

  35. Singh, G., Wilkinson, J. M. & Thomas, D. G. Supravesical diversion for incontinence: a long-term follow-up. Br. J. Urol. 79, 348–353 (1997).

    Article  CAS  PubMed  Google Scholar 

  36. Rinnab, L., Straub, M., Hautmann, R. E. & Braendle, E. Postoperative resorptive and excretory capacity of the ileal neobladder. BJU Int. 95, 1289–1292 (2005).

    Article  PubMed  Google Scholar 

  37. Kristjánsson A., Wallin, L. & Månsson, W. Renal function up to 16 years after conduit (refluxing or anti-reflux anastomosis) or continent urinary diversion. 1. Glomerular filtration rate and patency of uretero-intestinal anastomosis. Br. J. Urol. 7, 539–545 (1995).

    Article  Google Scholar 

  38. Samuel, J. D., Bhatt, R. I., Montague, R. J., Clarke, N. W. & Ramani, V. A. The natural history of postoperative renal function in patients undergoing ileal conduit diversion for cancer measured using serial isotopic glomerular filtration rate and 99m technetium-mercaptoacetyltriglycine renography. J. Urol. 176, 2518–2522 (2006).

    Article  PubMed  Google Scholar 

  39. Thoeny, H. C., Sonnenschein, M. J., Madersbacher, S., Vock, P. & Studer, U. E. Is ileal orthotopic bladder substitution with an afferent tubular segment detrimental to the upper urinary tract in the long term? J. Urol. 168, 2030–2034 (2002).

    Article  PubMed  Google Scholar 

  40. Minervini, R. et al. Effects on renal function of obstructive and nonobstructive and dilatation of the upper urinary tract in ileal neobladders with refluxing ureteroenteric anastomoses. Eur. J. Surg. Oncol. 36, 287–291 (2010).

    Article  CAS  PubMed  Google Scholar 

  41. Mills, R. D. & Studer, U. E. Metabolic consequences of continent urinary diversion. J. Urol. 161, 1057–1066 (1999).

    Article  CAS  PubMed  Google Scholar 

  42. Waidelich, R., Rink, F., Kriegmair, M., Tatsch, K. & Schmeller, N. A study of reflux in patients with an ileal orthotopic bladder. Br. J. Urol. 81, 241–246 (1998).

    Article  CAS  PubMed  Google Scholar 

  43. Nesbit, R. M. Ureterosigmoid anastomosis by direct elliptical connection; a preliminary report. J. Urol. 61, 728–734 (1949).

    Article  CAS  PubMed  Google Scholar 

  44. Studer, U. E. et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute—lessons to be learned. J. Urol. 176, 161–166 (2006).

    Article  PubMed  Google Scholar 

  45. Mattei, A., Birkhaeuser, F. D., Baermann, C., Warncke, S. H. & Studer U. E. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J. Urol. 179, 582–586 (2008).

    Article  PubMed  Google Scholar 

  46. Perimenis, P., Burkhard, F. C., Kessler, T. M., Gramann, T. & Studer, U. E. Ileal orthotopic bladder substitute combined with an afferent tubular segment: long-term upper urinary tract changes and voiding pattern. Eur. Urol. 46, 604–609 (2004).

    Article  PubMed  Google Scholar 

  47. Steers, W. D. Voiding dysfunction in the orthotopic neobladder. World J. Urol. 18, 330–337 (2000).

    Article  CAS  PubMed  Google Scholar 

  48. Hautmann, R. E., Volkmer, B. G., Schumacher, M. C., Gschwend J. E. & Studer, U. E. Long-term results of standard procedures in urology: the ileal neobladder. World J. Urol. 24, 305–314 (2006).

    Article  PubMed  Google Scholar 

  49. Stein, J. P., Ginsberg, D. A. & Skinner, D. G. Indications and technique of the orthotopic neobladder in women. Urol. Clin. North Am. 29, 725–734 (2002).

    Article  PubMed  Google Scholar 

  50. Ali-El-Dein, B., Gomha, M. & Ghoneim, M. A. Critical evaluation of the problem of chronic urinary retention after orthotopic bladder substitution in women. J. Urol. 168, 587–592 (2002).

    Article  PubMed  Google Scholar 

  51. Hautmann, R. E. Urinary diversion: ileal conduit to neobladder. J. Urol. 169, 834–842 (2003).

    Article  PubMed  Google Scholar 

  52. Stein, J. P., Penson, D. F., Wu, S. D. & Skinner, D. Pathological guidelines for orthotopic urinary diversion in women with bladder cancer: a review of the literature. J. Urol. 178, 756–760 (2007).

    Article  PubMed  Google Scholar 

  53. Lee, K. S., Montie, J. E., Dunn, R. L. & Lee, C. T. Hautmann and Studer orthotopic neobladders: a contemporary experience. J. Urol. 169, 2188–2191 (2003).

    Article  PubMed  Google Scholar 

  54. Nagele, U. et al. Radical cystectomy and orthotopic bladder replacement in females. Eur. Urol. 50, 249–257 (2006).

    Article  PubMed  Google Scholar 

  55. Borirakchanyavat, S., Aboseif, S. R., Carroll, P. R., Tanagho, E. A. & Lue, T. F. Continence mechanism of the isolated female urethra: an anatomical study of the intrapelvic somatic nerves. J. Urol. 158, 822–826 (1997).

    Article  CAS  PubMed  Google Scholar 

  56. Hugonnet, C. L., Danuser, H., Springer, J. P. & Studer, U. E. Decreased sensitivity in the membranous urethra after orthotopic ileal bladder substitute. J. Urol. 161, 418–421 (1999).

    Article  CAS  PubMed  Google Scholar 

  57. Kessler, T. M., Studer, U. E. & Burkhard, F. C. Increased proximal urethral sensory threshold after radical pelvic surgery in women. Neurourol. Urodyn. 26, 208–212 (2007).

    Article  PubMed  Google Scholar 

  58. Hautmann, R. E., Paiss, T. & de Petriconi, R. The ileal neobladder in women: 9 years of experience with 18 patients. J. Urol. 155, 76–81 (1996).

    Article  CAS  PubMed  Google Scholar 

  59. Stenzl, A. et al. Rationale and technique of nerve sparing radical cystectomy before an orthotopic neobladder procedure in women. J. Urol. 154, 2044–2049 (1995).

    Article  CAS  PubMed  Google Scholar 

  60. Studer, U. E. et al. Twenty years experience with an ileal orthotopic low pressure bladder substitute—lessons to be learned. J. Urol. 176, 161–166 (2006).

    Article  PubMed  Google Scholar 

  61. Hautmann, R. E., de Petriconi, R., Kleinschmidt, K., Gottfried, H. W. & Gschwend, J. E. Orthotopic ileal neobladder in females: impact of the urethral resection line on functional results. Int. Urogynecol. J. Pelvic Floor Dysfunct. 11, 224–229 (2000).

    Article  CAS  PubMed  Google Scholar 

  62. Bhatta Dhar, N., Kessler, T. M., Mills, R. D., Burkhard, F. & Studer, U. E. Nerve-sparing radical cystectomy and orthotopic bladder replacement in female patients. Eur. Urol. 52, 1006–1014 (2007).

    Article  PubMed  Google Scholar 

  63. Stein, J. P., Penson, D. F., Wu, S. D. & Skinner, D. Pathological guidelines for orthotopic urinary diversion in women with bladder cancer: a review of the literature. J. Urol. 178, 756–760 (2007).

    Article  PubMed  Google Scholar 

  64. Simon, J. et al. Neobladder emptying failure in males: incidence, etiology and therapeutic options. J. Urol. 176, 1468–1472 (2006).

    Article  CAS  PubMed  Google Scholar 

  65. Burkhard, F. C. & Studer, U. E. Orthotopic bladder substitution. Curr. Opin. Urol. 10, 343–349 (2000).

    Article  CAS  PubMed  Google Scholar 

  66. Abol-Enein, H. & Ghoneim, M. A. Functional results of orthotopic ileal neobladder with serous-lined extramural ureteral reimplantation: experience with 450 patients. J. Urol. 165, 1427–1432 (2001).

    Article  CAS  PubMed  Google Scholar 

  67. Parekh, D. J., Gilbert, W. B. & Smith, J. A. Jr . Functional lower urinary tract voiding outcomes after cystectomy and orthotopic neobladder. J. Urol. 163, 56–58 (2000).

    Article  CAS  PubMed  Google Scholar 

  68. Porru, D. et al. Urodynamic analysis of voiding dysfunction in orthotopic ileal neobladder. World J. Urol. 17, 285–289 (1999).

    Article  CAS  PubMed  Google Scholar 

  69. Nesrallah, L. J., Srougi, M. & Dall'Oglio, M. F. Orthotopic ileal neobladder: the influence of reservoir volume and configuration on urinary continence and emptying properties. BJU Int. 93, 375–378 (2004).

    Article  CAS  PubMed  Google Scholar 

  70. Shaaban, A. A., Mosbah, A., El-Bahnassawy, M. S., Madbouly, K. & Ghoneim, M. A. The urethral Kock pouch: long-term functional and oncological results in men. BJU Int. 92, 429–435 (2003).

    Article  CAS  PubMed  Google Scholar 

  71. Stein, J. P., Dunn, M. D., Quek, M. L., Miranda, G. & Skinner, D. G. The orthotopic T pouch ileal neobladder: experience with 209 patients. J. Urol. 172, 584–587 (2004).

    Article  PubMed  Google Scholar 

  72. Carrion, R. et al. A multi-institutional study of orthotopic neobladders: functional results in men and women. BJU Int. 93, 803–806 (2004).

    Article  CAS  PubMed  Google Scholar 

  73. Kulkarni, J. N., Pramesh, C. S., Rathi, S. & Pantvaidya, G. H. Long-term results of orthotopic neobladder reconstruction after radical cystectomy. BJU Int. 91. 485–488 (2003).

    Article  CAS  PubMed  Google Scholar 

  74. Studer, U. E. & Zingg, E. J. Ileal orthotopic bladder substitutes. What we have learned from 12 years' experience with 200 patients. Urol. Clin. North Am. 24, 781–793 (1997).

    Article  CAS  PubMed  Google Scholar 

  75. Brendler, C. B., Steinberg, G. D., Marshall, F. F., Mostwin, J. L. & Walsh, P. C. Local recurrence and survival following nerve-sparing radical cystoprostatectomy. J. Urol. 144, 1137–1140 (1990).

    Article  CAS  PubMed  Google Scholar 

  76. Cole, C. J. et al. Local control of muscle-invasive bladder cancer: preoperative radiotherapy and cystectomy versus cystectomy alone. Int. J. Radiat. Oncol. Biol. Phys. 32, 331–340 (1995).

    Article  CAS  PubMed  Google Scholar 

  77. Greven, K. M., Spera, J. A., Solin, L. J., Morgan, T. & Hanks, G. E. Local recurrence after cystectomy alone for bladder carcinoma. Cancer 69, 2767–2770 (1992).

    Article  CAS  PubMed  Google Scholar 

  78. Herr, H. W. Preoperative irradiation with and without chemotherapy as adjunct to radical cystectomy. Urology 25, 127–134 (1985).

    Article  CAS  PubMed  Google Scholar 

  79. Montie, J. E., Straffon, R. A. & Stewart, B. H. Radical cystectomy without radiation therapy for carcinoma of the bladder. J. Urol. 131, 477–482 (1984).

    Article  CAS  PubMed  Google Scholar 

  80. Skinner, D. G. & Lieskovsky G. Contemporary cystectomy with pelvic node dissection compared to preoperative radiation therapy plus cystectomy in management of invasive bladder cancer. J. Urol. 131, 1069–1072 (1984).

    Article  CAS  PubMed  Google Scholar 

  81. Skinner, D. G., Tift, J. P. & Kaufmann, J. J. High dose, short course preoperative radiation therapy and immediate single stage radical cystectomy with pelvic node dissection in the management of bladder cancer. J. Urol. 127, 671–674 (1982).

    Article  CAS  PubMed  Google Scholar 

  82. Westney, O. L. et al. Presentation, methods of diagnosis and therapy for pelvic recurrence following radical cystectomy for transitional cell carcinoma of the bladder. J. Urol. 159, 792–795 (1998).

    Article  CAS  PubMed  Google Scholar 

  83. Hautmann, R. E. & Simon, J. Ileal neobladder and local recurrence of bladder cancer: patterns of failure and impact on function in men. J. Urol. 162, 1963–1966 (1999).

    Article  CAS  PubMed  Google Scholar 

  84. Thurairaja, R., Burkhard, F. C. & Studer, U. E. The orthotopic neobladder. BJU Int. 102, 1307–1313 (2008).

    Article  PubMed  Google Scholar 

  85. Varol, C. & Studer, U. E. Managing patients after an ileal orthotopic bladder substitution. BJU Int. 93, 266–270 (2004).

    Article  CAS  PubMed  Google Scholar 

  86. Elting, L. S. et al. Correlation between annual volume of cystectomy, professional staffing, and outcomes: a statewide, population-based study. Cancer 104, 975–984 (2005).

    Article  PubMed  Google Scholar 

  87. Birkmeyer, J. D. et al. Hospital volume and surgical mortality in the United States. N. Engl. J. Med. 346, 1128–1137 (2002).

    Article  PubMed  Google Scholar 

  88. Birkmeyer, J. D. et al. Surgeon volume and operative mortality in the United States. N. Engl. J. Med. 349, 2117–2127 (2003).

    Article  CAS  PubMed  Google Scholar 

  89. Birkmeyer, J. D., Sun, Y., Wong, S. L. & Stukel, T. A. Hospital volume and late survival after cancer surgery. Ann. Surg. 245, 777–783 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  90. Hollenbeck, B. K., Wei, Y. & Birkmeyer, J. D. Volume, process of care, and operative mortality for cystectomy for bladder cancer. Urology 69, 871–875 (2007).

    Article  PubMed  Google Scholar 

  91. Granberg, C. F. et al. Functional and oncological outcomes after orthotopic neobladder reconstruction in women. BJU Int. 102, 1551–1555 (2008).

    Article  PubMed  Google Scholar 

  92. Nesrallah, L. J., Almeida, F. G., Dall'Oglio, M. F., Nesrallah, A. J. & Srougi, M. Experience with the orthotopic ileal neobladder in women: a mid-term follow-up. BJU Int. 95, 1045–1047 (2005).

    Article  PubMed  Google Scholar 

  93. Ali-el-Dein, B. et al. Surgical complications following radical cystectomy and orthotopic neobladders in women. J. Urol. 180, 206–210 (2008).

    Article  PubMed  Google Scholar 

  94. Stenzl, A. et al. Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors. Cancer 92, 1864–1871 (2001).

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Ulm, Boschstrasse 4a, Neu-Ulm, D-89231, Germany

    Richard E. Hautmann

  2. Department of Urology, Klinikum Luedenscheid, University of Bonn, Paulmannshoeher Strasse 14, Luedenscheid, D-58515, Germany

    Stefan H. Hautmann

  3. Department of Trauma Surgery, University of Malaya Medical Center, Kuala Lumpur, 50603, Malaysia

    Oliver Hautmann

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R. E. Hautmann, S. H. Hautmann and O. Hautmann contributed equally to the researching of data, discussion of content and reviewing of this manuscript before submission. R. E. Hautmann wrote the article.

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Hautmann, R., Hautmann, S. & Hautmann, O. Complications associated with urinary diversion. Nat Rev Urol 8, 667–677 (2011). https://doi.org/10.1038/nrurol.2011.147

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