Urinary Diversion: Historical Aspect and Patient’s Satisfaction

During the last decades, the techniques of urinary diversion after radical cystectomy for muscle-invasive bladder cancer have evolved from simple diverting techniques through a conduit to the orthotopic neobladder reconstruction thus providing a safe and continent reservoir to store and eliminate urine with efforts to provide an improved quality of life [1]. Sir John Simon is credited with performing the first ureteroproctostomy for bladder exstrophy in 1851. Simon attempted ureterosigmoidostomies in dogs by bringing the ureters into intimate contact with the rectum below the peritoneal reflection in order to create a fistula using silk sutures. Subsequently, Lloyd attempted a similar technique in an exstrophy patient resulting in peritonitis and death at the 7th postoperative day [2]. In 1879, Thomas Smith utilized a two layer technique with direct anastomosis of ureteral mucosa to bowel mucosa with a second line of sutures used to close the sero muscular layers of the bowel around the ureter. In 1892, Karl Maydl tried to decrease the high incidence of ureterointestinal strictures by implanting an ellipse of trigone carrying Urinary Diversion: Historical Aspect and Patient’s Satisfaction