Current and Innovative Approaches to Bladder Substitution and Urinary Diversion: Strategies to Minimize Gut Related Complications

Bladder cancer is the second most common genitourinary malignancy worldwide. Nearly one-third of patients harbor muscle-invasive bladder cancer (MIBC) at diagnosis. Radical cystectomy with urinary diversion (UD) represents the standard of care for MIBC. Traditionally, urologists have leveraged natural intestinal tissue for UD after radical cystectomy. Unfortunately, the use of intestine for UD may lead to numerous complications, including prolonged ileus, metabolic acidosis, B12 deficiency, ureter-enteric fistulas, infection, and obstruction. Given this, urologists have sought to find suitable alternatives to gut-based UD to avoid the plethora of complications associated with its use. Tissue engineering methods continue to evolve in pursuit of substitutes that are bereft of the morbidities associated with intestinal tissue. In this review, we explore novel approaches to UD with emphasis on future perspectives of tissue engineering–based alternatives. We also describe possible alternatives for UD using tissue expander–based methods.