Patient decision aids for urinary diversion after radical cystectomy: their potential and pitfalls

We read, with interest, the manuscript by McAlpine et al. outlining their development of patient decision aids (PtDA) to assist patients undergoing cystectomy in deciding which type of urinary diversion to have performed. The two main types of urinary diversion dealt with by McAlpine et al. are ileal conduit diversion and orthotopic neobladder formation as these are the two most commonly performed urinary diversions (1,2). Both techniques have significant implications for the patient’s future quality of life and some consequences may not be acceptable for some patients (1). The ileal conduit is well recognised as the most simple type of urinary diversion but may be unsatisfactory to some patients due to the presence of an abdominal stoma (3). Orthotopic neobladders are often felt to have better results in terms of a patient’s body image, given it’s closer mimicking of the position of the bladder, but have associated issues with incontinence and potentially the need to self-catheterise which may be unacceptable to some patients (3,4). These very different aspects of each urinary diversion highlight the need to thoroughly counsel patients pre-operatively, as recommended by the World Health Organisation Consensus Conference on Bladder Cancer (5). Patients must weigh the advantages and disadvantages of either option of urinary diversion in order to come to a decision. The development of a PtDA by McAlpine et al. is therefore an incredibly useful tool for both patients and clinicians for use in shared decision making.