Is there any evidence that one continent diversion is any better than any other or than ileal conduit?

There is an obvious discrepancy between the perceived advantages of the different forms of continent urinary diversion from an expert's point of view and the limited utilization of these techniques outside of academic and tertiary referral centers.

The vast majority of studies are retrospective with numerous confounding factors and often poorly defined outcomes. The rates of postoperative morbidity and need for reoperation varies widely among studies, even for the same procedure. The utilization of continent diversion depends on demographic, socioeconomic, provider-based, and clinical variables, with low case volume and lack of experience probably being the most obvious reasons for avoidance of more complex techniques. In contrast to the prevailing notion that patients undergoing continent diversion have superior quality of life than those receiving a conduit, existing studies fail to show significant advantages of one technique over the other.

The current body of published literature is insufficient to conclude that there is a superior form of urinary diversion in terms of evidence-based medicine. It is quite clear, however, that not all patients are candidates for one type of diversion. The best results are obtained when a comprehensive concept is tailored to the individual patient.