HISTORY OF URINARY-DIVERSION

In 1852, Simon was the first to describe a urinary diversion using int estinal segments. In the late 19th and early 20th century, in the abse nce of antibiotics, urinary diversion using bowel segments carried a h igh risk of peritonitis. When Coffey introduced a new method for urete ric implantation in 1911, ureterosigmoidostomy became the most frequen tly used technique. The ileal conduit, first described by Zaayer in 19 11, was established as a standard technique by Bricker in 1950. At the same time, Ferris and Oedel demonstrated a hyperchloremic metabolic a cidosis in 80% of the patients with ureterosigmoidostomy, and the ilea l conduit became the preferred form of urinary diversion. The first at tempts to create a continent urinary diversion were undertaken by Tizz oni and Foggi in 1888. Mauclaire, in 1895, used the isolated 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 Lapi des popularized the use of clean intermittent catheterization. Utilizi ng 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 firs t 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 biodegr adable polymers as a scaffold is feasible, and future developments may be vastly influenced by these techniques.