Although the ileal conduit must be regarded as the "gold standard" technique of urinary diversion, many long-term complications result and patients must wear urinary collection devices with their associated psychological and social limitations. The recent interest in continent diversions was primarily an attempt to improve the quality of life rather than improve survival or reduce renal and metabolic complications. Although continent stomas can be achieved with low pressure reservoirs fashioned from detubularised or augmented bowel, many operations may be required to perfect the continent stoma. Long-term results using continent reservoirs are awaited. It seems that a bladder substitute using reconfigurated bowel is preferable to a continent reservoir but continence remains a problem and all of the techniques lack long-term follow-up. The use of bladder substitutes in females is limited by the need to use a prosthetic sphincter to achieve continence.