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By the late 1950s, the ileal conduit became the established urinary diversion technique, and the high mortality and morbidity rates associated with pelvic exenteration began to decline [30]. In particular the procedure avoided the complications of implanting ureters into an intact colon and could be fashioned from ileum that was undisturbed by any pre‐existing radiotherapeutic field [31]. Despite these benefits, the complex nature of exenterative surgery made significant postoperative complications associated with urinary diversion were considered unavoidable, particularly the development of urinary fistulas [15, 32]. Brunschwig observed that, in patients who survived > 5 years “the most frequent subsequent cause of death is the deterioration of the diverted urinary tract” [33]. He advocated continuous surveillance of the urinary diversion and for the early use of temporary or permanent nephrostomy tubes for any evidence of obstruction [33].

Today, en‐bloc cystectomy is required in approximately half of all patients undergoing pelvic exenteration [34–37]. Despite much progress, postoperative urological complications remain a major cause of morbidity, prolonging hospital admission and impacting on quality of life [35]. Major complication rates between 9 and 24% are reported, with urinary leak rates occurring in 7–16% of patient [35–37]. Newer techniques for continent urinary diversion, such as the internal ileal pouch reservoir [38, 39], remain controversial. Alternatives like the Indiana pouch and the Miami pouch are suitable in highly selected patients [40, 41].