Current status of urinary diversion

The need for urinary diversion is widespread for both benign and malignant disease and for patients of all ages. In the past 25 years, the urinary conduit concept of diversion has been the most widely practiced modality and has produced results that have been gratifying and acceptable, though not perfect. It is doubtful that a “perfect” solution to bladder substitution will ever be found, i.e., a solution without complications and without risk to long‐term renal function. Of the various conduit operations, ileal conduit has been the one most widely employed. This procedure has produced a lower incidence of pyelonephritis and hyperchloremic acidosis than any method of diversion prior to 1950. However, it has been associated with significant complications and a threat to long‐term renal function is now being recognized. Various efforts at improving these results are under way, aimed chiefly at avoiding the effects of ureteral anastomosis to irradiated bowel and at the development of non‐refluxing ureteral anastomoses. Only time and careful study will determine the results of these efforts. We should adopt standardized parameters in the next 25 years in order to make meaningful comparisons possible. The parameters of greatest importance are a definition of complications clearly resulting from the diversion, a definition of pyelonephritis, and an agreement on a standard definition of “renal deterioration.”