ABSTRACT
When Eugen Bricker more than 50 years ago popularized urinary diversion by an ileal conduit,1 he probably had not foreseen that this type of diversion would still be the one most frequently performed in the world at the beginning of the twenty-first century. Reasons for its popularity have, however, evolved over the years, and partly depend on the technical versatility of the surgeon to perform the two basic dry diversions now validated: orthotopic and continent cutaneous bladder replacement. In the 1950s and 1960s, the ileal conduit was favored because it overcame four main problems of urinary diversion. It markedly decreased the problems of electrolyte imbalance and pyelonephritis following ureterosigmoidostomy,2 and provided the patient with a unique single stoma whose appliance was much simpler and more reliable than that of bilateral uretero-, nephro-or pyelostomies. Nowadays, the ileal conduit remains very much appreciated throughout the world owing to its technical simplicity and long-term effectiveness.3,4 Indeed, although not devoid of late complications,3-6 the procedure has undoubtedly stood the test of time. Except after pelvic irradiation, ileum is the best small bowel segment to be used for conduit construction, and it remains superior to the jejunum which carries a 40-65% risk of electrolyte imbalance.7-8 Moreover, although conduit diversion has long carried the reputation of poor self body image associated with a low quality of life, studies have shown that a large proportion of patients are well satisfied with this type of diversion.9-11 Interestingly, the underlying cause for the diversion appears more likely to affect subsequent quality of life issues, and cancer patients seem more prone to curtail social activities compared with those undergoing diversion for a benign pathology, such as incontinence or bladder dysfunction.12 This chapter reviews the indications, complications of and quality of life after one of the classical urologic operations. It does not cover the laparoscopic aspect, which is dealt with in Chapter 38.
