Technique of Ileal Conduit—Evolution of the Brady Method

It may seem presumptuous, and it may really be presumptuous, to write on the technique of ileal conduit surgery for an audience of highly trained urologists who competed successfully in an active residency training program and who have, as a group, pursued distinguished careers. On the other hand, though the mortality of the ileal conduit operation is below 2% in patients operated upon for benign disease, morbidity figures, particularly those reflecting long-term complications, remain quite variable. As an example, persistent infection is reported in some series in upward of 60% of conduits in patients with normal upper tracts. In my patients, this figure is about 10 in a comparable group. James Holland, reviewing “high” ileal conduits—those attached directly to the renal pelvis—found that only 40% remained infected in the postoperative period, a surprisingly good result when one considers that this form of diversion is elected most often in patients with extreme hydronephrosis(9). These better results are probably directly related to operative technique and since the technique to be described, albeit with many digressions, evolved at Brady over the years 1955–1962, it seems a particularly apt subject for description and review in a Festschrift piece written to honor Dr. William W. Scott on his twenty-fifth anniversary as Chariman of the Division of Urolgy at Johns Hopkins.