The following three main modalities are most commonly used in clinical practice: i. Ureteral skin stoma: The end of the ureter is directly incised in the skin of the abdominal wall, which is a simple and safe surgical procedure. There are few complications directly related to the surgery. However, the quality of life is poor, the abdominal wall urinary collection device is prone to leakage, regular ureteral catheter changes are required, and the incidence of urinary tract infections is high. It is indicated for those with short life expectancy, distant metastases, total palliative cystectomy, intestinal disorders that preclude the use of the bowel for urinary diversion, or a systemic state that does not tolerate the procedure.
Second, ileal cystectomy (ileal catheterization, Bricker procedure) is a classic optional procedure. A section of ileum is amputated as an output tract, closed at one end and anastomosed to the end of the ureter, and the other end is stomaed to the abdominal wall. Postoperatively, only one stoma is needed to collect urine, which is relatively easy to collect and does not require a tube inside the body. The main disadvantage is the need for an abdominal wall stoma and the wearing of a urine collection bag for life. The surgical complications and postoperative long-term complications are lower than those of neobladder surgery.
Third, in situ neobladder is usually made by using the terminal ileum to make a storage sac instead of the bladder, with one end anastomosed to the end of the ureter and the other end anastomosed to the urethra. The main advantage is that it does not require an abdominal wall stoma, still urinates from the urethra and has little impact on quality of life. The disadvantage is that nocturnal incontinence and voiding failure require catheterization. The incidence of complications such as urinary retention, metabolic diseases, urinary incontinence, and uretero-intestinal anastomotic strictures is high. Another disadvantage is the recurrence of urethral tumors.