Each year approximately 40,000 new cases of rectal cancer are diagnosed in the United States, comprising nearly 30% of all colorectal malignancies. Locally advanced rectal cancer may often require an extensive pelvic operation. Despite the increase in sphincter-sparing operations, the abdominoperineal resection (APR) remains the operation of choice for many low-lying rectal cancers, certain recurrent rectal cancers, as salvage therapy for anal cancers, as well as advanced gynecologic and genitourinary malignancies. For tumors that involve adjacent organs requiring multivisceral resection, pelvic exenteration is performed to achieve negative margins in accordance with standard oncologic principles. With exenteration, en bloc resection of the bladder, urethra, and rectum is performed along with the prostate in men, and uterus, ovaries, fallopian tubes, and vagina in women—all to various degrees depending on the individual tumor extent. Although the procedure involves formation of a permanent colostomy for the gastrointestinal (GI) tract, restoration of the genitourinary system requires reconstruction of a new bladder. The ileal conduit is one type of non-continent urinary diversion procedure that was first described by Seiffert in 1935, and subsequently popularized since the 1950s by Bricker and Wallace. Although having certain nuances, it is a relatively straightforward and reproducible technique that has been the most commonly used urinary diversion method after pelvic exenteration for several years. This operation encompasses isolating a loop of distal ileum to create the neo-bladder, attaching the ureters, and restoration of the GI continuity through an ileal-ileal, ileocolic, or ileorectal anastomosis.

Contraindications to the use of an ileal conduit include chronic problems associated with the intestine to include small bowel Crohn’s disease and other inflammatory conditions. It is also contraindicated in patients with renal impairment secondary to long-term obstruction or chronic renal failure. For select patients who require urinary diversion, an alternative to ileal conduit includes an orthotopic bladder substitution.