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The key challenge in extended pelvic resection was urinary tract reconstruction. Though urinary diversion techniques had been described since 1852, leakage and infection issues resulted in many modifications in technique over the last century [23]. In 1909, Verhoogan and De Graeuwe (Brussels, Belgium) implanted ureters into an isolated segment of terminal ileum draining via an appendicostomy [24]. However, isolated ileal segments temporarily fell out of use [25]. Over the next three decades, Robert C. Coffey (Oregan, USA) experimented with various methods of bladder substitution by implanting ureters into the residual colon [26, 27]. Although he presented his outcomes outcomes in 1925 they were never published because “exposure of the ureters and kidneys to the fecal stream often led to sepsis, hyperchloremic acidosis, and kidney failure” [24]. Brunschwig’s favored technique of “wet colostomy” was essentially reproduction of Coffey’s method and suffered from the same shortcomings [22].

Other pioneers interested in this type of surgery had also attempted the creation of artificial bladders from bowel or alternatively developing cutaneous ureterostomies [22]. Appleby (Vancouver, Canada) examined the possibility of transferring both ureters to an intact cecum draining through a sigmoid colostomy, but with limited effect [7]. Similarly, Bricker created a diversion that involved isolation of a cecal segment “to be drained intermittently of urine through a catheter” [6]. Gilchrist and colleagues reported attaining successful continence with the construction of an intra‐abdominal reservoir from isolated cecum draining via the terminal ileum [28]. However, Bricker was unable to duplicate these results and chronic leakage of urine frustrated clinicians and patients alike (Figure 1.2) [29].

Figure 1.1 (a) Levels of transection of the ureters (U) and colon (C) and incision encompassing the vulva (V) and anus (PW) from Brunschwig’s original article. (b) Conditions at end of operation, indicating areas of peritonectomy (shaded area, P, P′, PI″, and PI‴). Midline colostomy is shown with both ureters (U and U′) implanted into the colon a short distance above colostomy. Copyright © 1948 American Cancer Society.

Source: Reproduced with permission from John Wiley & Sons Ltd. [1].