Urinary undiversion with implantation of an artificial urethral sphincter

Urinary undiversion was performed in a 21-year-old man with a contracted flaccid bladder. The steps of the procedure were: bladder dilatation; antireflux implantation of an ileal conduit into the bladder; external sphincterotomy, and implantation of an artificial urethral sphincter. The patient is continent and has a good bladder capacity and emptying. In many patients with urinary ileal conduit diversion, upper urinary tract and stomal problems develop after some years. In these patients urinary undiversion must be considered but, so far, evaluation showing a high risk of postoperative incontinence has been regarded as a contraindication to urinary undiversion. However, the introduction of artificial urethral sphincters has made it possible to perform undiversion procedures in many of these patients in whom the bladder capacity and bladder emptying is acceptable, if a nonobstructed outlet is secured. We describe the findings and procedures in a patient undergoing urinary undiversion with implantation of an artificial sphincter 8 years after urinary diversion due to neurological disorders caused by a myelomeningocele.