Urinary Diversion: patients’ acceptance and quality of life

It is clear that no one urinary diversion suits all patients – a variety of approaches allows in depth counselling of patients and a feeling of ‘choice’. Regardless of the decision made any patient undergoing such surgery must be able to accept the surgical and physical changes alongside the psychological impact. There is currently no validated means to measure acceptance. Health Related Quality of life (HRQoL) may be thought of a surrogate measure and is often high following urinary diversion. Thus could be interpreted as a retrospective validation of patient selection – in its simplest form this could create the dangerous misconception that urologists should offer an ileal conduit as the standard. In modern urinary diversion, high patient acceptance develops from comprehensive pre-operative counselling, setting realistic expectations, careful patient-to-method-matching, strict adherence to surgical detail during the procedure and a meticulous lifelong follow-up. Misjudgements in patient or diversion selection may result in harm to a patient’s physical or psychological health. This will undermine the factors behind success which include individual coping strategies, disease related social support and confidence in the success of treatment. A reconstructive surgeon must have all appropriate surgical options available and choices need to be tailored to an individual’s needs. My formula for greatness in man is amor fati: the fact that a man whishes nothing to be different, either in front of him or behind him, or for all eternity. Not only must the necessity be borne, and on no account concealed [...] but it must also be loved. Friedrich Nietzsche, Ecce homo, Warum ich so klug bin, 1888 [1] All Sisyphus' silent joy is contained therein. His fate belongs to him. His rock is a thing. [...] Each atom of that stone, each mineral flake of that night filled mountain, in itself forms a world. The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy. Albert Camus, Le Mythe de Sisyphe, 1942 [2]