Bladder Reconstruction and Diversion during Colorectal Surgery

Extirpative procedures for advanced colorectal cancers can involve multivisceral pelvic resections. In patients without evidence of distant metastatic disease, a reasonable therapeutic effect can be expected when negative surgical margins are obtained. For patients with bladder involvement, the decision to perform a bladder-sparing procedure or a total pelvic exenteration will be based on the extent of the primary lesion as well as patient characteristics. In this article, the authors describe bladder-sparing techniques with and without enterocystoplasty as well as options for urinary diversion in patients requiring total pelvic exenteration. Contraindications and clinical decision making regarding bladder reconstruction or replacement are discussed.