Urinary diversion into bowel segments is not inherently damaging to the kidneys. In general, renal function after diversion into continent detubularized reservoirs compares favorably with ileal conduit diversion. However, the literature is insufficient to recommend one form of diversion over another. There remains a long-term risk of renal deterioration, which is often asymptomatic, and thus close follow-up is necessary for all patients who have undergone urinary diversion in order to identify correctable causes early.

Those with renal pathology prior to surgery seem to be at greatest risk of postoperative renal deterioration. Serum creatinine is an imprecise measure of renal function. Isotopic GFR measurement will detect renal function deterioration most accurately and at an early stage. The latter, however, is not available to all patients. In these situations, follow-up with serum creatinine and ultrasound should be followed by diuresis renography if upper tract dilation is seen. Early intervention for physical obstruction often results in a sustained improvement in renal function [2].

Patients who have undergone conduit diversion, continent cutaneous diversion, or orthotopic bladder substitution do not seem to be at increased risk of secondary malignancy. By comparison, the risk is slightly higher after cystoplasty, albeit not increased enough to support endoscopic surveillance. However, the present knowledge regarding gastric cystoplasty is insufficient, and hence patients should be followed after such surgery. Furthermore, yearly colonoscopy is recommended in cases involving ureterosigmoidostomy, beginning 10 years after the procedure [2].

Radical cystectomy and urinary diversion are two steps of one operation. However, the literature notoriously reports on complications of radical cystectomy, ignoring that the vast majority of complications are diversion-related [3]. Surgical morbidity following urinary diversion is significant and, when strict reporting guidelines are incorporated, higher than previously published (20–57 %). Accurate reporting of postoperative complications after radical cystectomy is essential for counseling patients, combined modality treatment planning, clinical trial design, and assessment of surgical success [3].