Current Trends in Urinary Diversion in Men

Prior to the introduction of the ileal conduit more than four decades ago, the options for urinary diversion after cystectomy were extremely limited. Direct cutaneous anastomoses of the collecting system (cutaneous pyelostomies, ureterostomies) offered patients a short-term diversion, but the benefits were outweighed by significant complications: recession or stenosis of the stoma. The first choice of diversion was the ureterosigmoidostomy with or without antireflux technique. Then it fell in popularity and was replaced with continent/non-continent uretero-ileo-cutaneous diversions. Only in the last years the continent orthotopic neobladder has been widely employed as first procedure choice. At present, patients can be offered a non-continent cutaneous diversion, a continent cutaneous diversion or an orthotopic neobladder urinary reconstruction (ONR).