[Continent urinary diversion]

Abstract

Even recognising that no suitable method of urinary by-pass is yet available, continent by-passes provide the still valid cutaneous ureteroilestomy with the possibility of not having to carry a collector pouch as well as better long-term preservation of renal function. This paper reviews the different techniques used nowadays, explaining their advantages and disadvantages. Kock's is presented as a versatile method which allows its use as a reservoir or a vesical orthotropic substitution, with low complications rate in ureteroileal anastomosis, but at the expense of a greater difficulty of execution. Indiana's Pouch is an easy-to-perform technique with good results and low reoperations rate. The possibility of long-term metabolic complications and, even more, the need of the patient's collaboration who must fulfil some minimum requirements of manual ability and understanding of the intervention carried out, are crucial items in the conduct of continent urinary by-passes.