Description

Introduction

The ureterosigmoidostomy is the oldest known form of urinary diversion. It is noteworthy, however, that the much quoted original paper on the subject by Simon was a post mortem report of a single case! Once established, its short-comings became well known: incontinence, renal infection and poorly understood metabolic disorders (now known to be due to hyperchloraemic acidosis). The risks of neoplasia were only recognised much later, probably because the majority of patients did not live long enough to be at risk. The ureterosigmoidostomy was the standard diversion for those who had a functioning anus until the advent of the ideal conduit. Ironically, this happened at about the same time that the problems of the former were becoming understood. A further 40 years were to pass before the shortcomings of the ideal conduit were known and the principles learnt from continent diversions could be applied to Simons original concept.