Selecting the appropriate urinary diversion procedure in the spinal cord injured: a poignant reminder

Lower urinary tract reconstruction has been performed on the spinal injured population at our institution since 1988. Careful pre-operative evaluation including a detailed history, physical examination and radiographic and/or urodynamic studies are usually obtained to determine which type of procedure would be most beneficial for each individual patient. Typically, patients receive either a cutaneous (i.e., Kock or Indiana) diversion or undergo a form of bladder augmentation (usually ileocystoplasty). Pre-operative findings and the patient's history are carefully considered prior to choosing the appropriate procedure. Occasionally, a particular finding influences the decision. We describe a patient who received a hemi-Kock ileocystoplasty with a continent abdominal stoma who, in retrospect, would have benefitted from a supravesical diversion.