Technique of Extracorporeal Urinary Diversion

  • Avinash Chennamsetty
  • Kevin G. ChanEmail author


The purpose of this chapter is to provide a step-by-step approach to the different extracorporeal urinary diversions that may be performed in the setting of robot-assisted laparoscopic radical cystectomy (RARC). Recent reports indicate comparable results to open surgery with regard to intermediate-term oncological outcomes and extent of pelvic lymph node dissection. However, operative times are one of the main obstacles that hinder widespread acceptance of RARC. Extracorporeal urinary diversion with RARC provides a method of reconstruction that mirrors that of open surgery with regard to operative times. Complication rates and functional outcomes with extracorporeal urinary diversion also appear comparable to open series.

We will discuss in detail the extracorporeal techniques of a Studer orthotopic neobladder, Indiana pouch continent cutaneous urinary diversion, and ileal conduit urinary diversion. At our institution, we have performed more than 550 RARCs. Urinary diversions were primarily performed extracorporeally and the majority were continent urinary diversions. We describe our technique that follows a common template, which can be applied to all types of urinary diversion.


  1. 1.
    Kauffman EC, et al. Early oncologic outcomes for bladder urothelial carcinoma patients treated with robotic-assisted radical cystectomy. BJU Int. 2011;107(4):628–35.CrossRefPubMedGoogle Scholar
  2. 2.
    Pruthi RS, et al. Robotic radical cystectomy for bladder cancer: surgical and pathological outcomes in 100 consecutive cases. J Urol. 2010;183(2):510–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Snow-Lisy DC, Campbell SC, Gill IS, et al. Robotic and laparoscopic radical cystectomy for bladder cancer: long-term oncologic outcomes. Eur Urol. 2014;65:193–200.CrossRefPubMedGoogle Scholar
  4. 4.
    Styn NR, Montgomery JS, Wood DP, et al. Matched comparison of robotic-assisted and open radical cystectomy. Urology. 2012;79:1303–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Menon M, et al. Robot-assisted radical cystectomy and urinary diversion in female patients: technique with preservation of the uterus and vagina. J Am Coll Surg. 2004;198(3):386–93.CrossRefPubMedGoogle Scholar
  6. 6.
    Josephson DY, et al. Robotic-assisted laparoscopic radical cystoprostatectomy and extracorporeal continent urinary diversion: highlight of surgical techniques and outcomes. Int J Med Robot. 2010;6(3):315–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Chan KG, Guru K, Wiklund P, et al. Robot-assisted radical cystectomy and urinary diversion: technical recommendations from the Pasadena consensus panel. Eur Urol. 2015;67:423–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Studer UE, et al. Three years’ experience with an ileal low pressure bladder substitute. Br J Urol. 1989;63(1):43–52.CrossRefPubMedGoogle Scholar
  9. 9.
    Rocco F, Gadda F, Acquati P, et al. Personal research: reconstruction of the urethral striated sphincter. Arch Ital Urol Androl. 2001;73(3):127–37.PubMedGoogle Scholar
  10. 10.
    Ahlering TE, Weinberg AC, Razor B. Modified Indiana pouch. J Urol. 1991;145(6):1156–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Brooke BN. The management of an ileostomy, including its complications. Lancet. 1952;2(6725):102–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Geltzeiler CB, Rotramel A, Wilson C, Deng L, Whiteford MH, Frankhouse J. Prospective study of colorectal enhanced recovery after surgery in a community hospital. JAMA Surg. 2014;149:955–61.CrossRefPubMedGoogle Scholar
  13. 13.
    Chennamsetty AC, Kardos SV, Yuh B, Yamzon J, Ruel NH, Crocitto L, Lau CS, Chan KG. Robotic assisted radical cystectomy: improving outcomes over the years despite worsening patient co-morbidities. Paper presented at American Urological Association—Western Section Annual Meeting, Kauai, Hawaii. 2016.Google Scholar
  14. 14.
    Chan KG, Collins JW, Wiklund NP. Robot-assisted radical cystectomy: extracorporeal vs intracorporeal urinary diversion. J Urol. 2015;193(5):1467–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Ahmed K, Khan SA, Hayn MH, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014;65:340.CrossRefPubMedGoogle Scholar
  16. 16.
    Jankowski J, Wilson TG, Josephson DY, Chan KG, Lau CS, Nelson RA, Crocitto LE. Defining early morbidity of robotic-assisted radical cystectomy using a standardized reporting methodology. J Urol. 2009;181(4):631.CrossRefGoogle Scholar
  17. 17.
    Bochner BH, Dalbagni G, Sjoberg DD, et al. Comparing open radical cystectomy and robot-assisted laparocopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67:1042–50.CrossRefPubMedGoogle Scholar
  18. 18.
    Wang GJ, Barocas DA, Raman JD, et al. Robotic vs open radical cystectomy: prospective comparison of perioperative outcomes and pathological measures of early oncological efficacy. BJU Int. 2008;101:88–93.Google Scholar
  19. 19.
    Nix J, Smith A, Kurpad R, et al. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol. 2010;57:196–201.CrossRefPubMedGoogle Scholar
  20. 20.
    Ng CK, Kauffman EC, Lee MM, et al. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol. 2010;57:274–81.CrossRefPubMedGoogle Scholar
  21. 21.
    Steven K, Poulsen AL. The orthotopic Kock ileal neobladder: functional results, urodynamic features, complications and survival in 166 men. J Urol. 2000;164:288–95.CrossRefPubMedGoogle Scholar
  22. 22.
    Yuh B, Wilson T, Bochner B, et al. Systemtic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy. Eur Urol. 2015;67:402–22.CrossRefPubMedGoogle Scholar
  23. 23.
    Torrey RR, Chan KG, Yip W, et al. Functional outcomes and complications in patients with bladder cancer undergoing robotic-assisted radical cystectomy with extracorporeal Indiana pouch continent cutaneous urinary diversion. Urology. 2012;79:1073–8.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of UrologyCity of Hope National Medical CenterDuarteUSA

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