Revisited Non Continent Urinary Diversio

Since the middle of the 19th century, several types of non-continent urinary diversion (NCUD) have been developed. However, the most often performed is the ileal conduit firstly described by Bricker early in the fifties. Another NCUD used especially in unfit patients is bilateral cutaneous ureterostomy. The ileal conduit changed with time. While it was lengthy, extraperitoneal and stitched to the sacrum, it is nowadays shorter, between 5 and 10 cms long according to the abdominal wall thickness. Therefore, the contact between urine and the bowel is limited decreasing the risks of reabsorption and metabolic acidosis. In parallel, uretero-ileal anastomosis techniques were simplified and are either termino-lateral or termino-terminal as suggested by Wallace.Nowadays, ileal conduit can be fashioned either completely intracorporeally by pure or robot-assisted laparoscopic techniques or extracorporeally through a minilaparotomy incision. However, higher morbidity has been reported when it was performed completely intracorporeally by pure laparoscopic technique as compared to when the urinary diversion was constructed extracorporeally. On the other hand, randomised trial showed no differences when the cystectomy was performed using the robot.Finally, fast track rehabilitation methods developed in bowel surgery have been adapted to the bladder surgery allowing a shortened time of postoperative ileus and a shorter hospital stay.