A narrative review of the state of urinary diversion: ileal conduit, neobladder, continent cutaneous, and cutaneous ureterostomy.

Background and Objective: Several urinary diversion (UD) options are available after radical cystectomy (RC); however, there is a paucity of comparative evidence to guide patient counseling and shared decision-making. Level I evidence is limited in this domain and controversy exists regarding key clinical points like how patient age, comorbidities, renal function, tumor characteristics, functional expectations, surgeon experience, quality-of-life priorities, and long-term complication profiles should influence UD choice. The purpose of this narrative review is to provide surgical information and clinical points on ileal conduits (ICs), neobladders, continent cutaneous diversions, and cutaneous ureterostomies (CUs). Methods: A primary literature review was performed through 03/01/2026 followed by a second final review through 07/26/2026 on the aforementioned UDs using a multitude of keywords. Articles were indexed in PubMed, PubMed Central, Google Scholar, Directory of Open Access Journals, and Cochrane Library. Societal guidelines on bladder cancer were also reviewed and incorporated into the review. All articles were in the English language. Additionally, surgical textbooks were reviewed for key surgical steps. Search terms were predefined and refined to capture studies addressing surgical technique, patient selection, complications, and clinical implications. Key Content and Findings: ICs are the most frequently utilized in contemporary practice. They are useful for their broad patient eligibility and minimal upkeep for patients. Complications like ileus, stricture, leak, and metabolic derangements are common. The neobladder allows patients the ability to retain urinary continence, but rates are not defined enough in the literature. Continent cutaneous diversions are not as frequently used after RC, and there are a broad range of choices at the disposal of the surgeon. These are often considered the most technically difficult to create, and there is a window for prospective research on the UDs given the paucity of data currently in the literature. CUs have minimal restrictions on eligibility and avoid bowel work and are a useful option for frail and elderly patients. Conclusions: UD selection should be a combination of surgeon ability, patient comorbidities, and patient preference through shared decision making.