History of urinary diversion

In 1852, Simon was the first to describe a urinary diversion using intestinal segments. In the late 19th and early 20th century, in the absence of antibiotics, urinary diversion using bowel segments carried a high risk of peritonitis. When Coffey introduced a new method for ureteric implantation in 1911, ureterosigmoidostomy became the most frequently used technique. The ileal conduit, first described by Zaayer in 1911, was established as a standard technique by Bricker in 1950. At the same time, Ferris and Oedel demonstrated a hyperchloremic metabolic acidosis in 80% of the patients with ureterosigmoidostomy, and the ileal conduit became the preferred from of urinary diversion. The first attempts to create a continent urinary diversion were undertaken by Tizzoni and Foggi in 1888. Mauclaire, in 1895, used the isolatec rectum as a urinary reservoir. Two findings were essential for the development of modern continent urinary diversion: Kock established the principle of bowel detubularization to create a low-pressure reservoir, and Lapides popularized the use of clean intermittent catheterization. Utilizing these techniques, a variety of continent reservoirs were introduced. The majority of these used either ileal segments, like the Hautmann neobladder, or ileocecal segments, like 'Le Bag'. Sinaiko was the first to use the stomach for the creation of a urinary reservoir in 1956. Continent urinary diversion is the method of choice in a large number of patients today. Experimental work demonstrated that the creation of a new bladder using cultured urothelial and muscle cells with biodegradable polymers as a scaffold is feasible, and future developments may be vastly influenced by these techniques.