Undiverting the ileal conduit

The experience described herein reinforces the belief that it is worthwhile to consider undiversion of the urinary tract in any patient in whom the indication for diversion initially was, upon reexamination, questionable. In children the optimum time for this appears to be as the candidate approaches adolescence, since by then he has outgrown most of the incoordination of childhood and is likely to be highly motivated toward the idea of being freed from the external appliance. Evaluation of such patients requires consideration of many factors but the best guide to bladder potential is probably provided by the placement of a suprapubic catheter followed by bladder filling and voiding exercises. Finally, a careful analysis of the anatomy of the urinary tract is essential if the operation is to be undertaken safely and effectively. None of these steps is easy but the potential rewards are so great as to make them well worth the effort expended.