It is well known that radical total cystectomy is the most effective means of treating muscle-invasive bladder cancer and some high-risk non-muscle-invasive bladder cancers. Then it inevitably involves the issue of urinary diversion, i.e. how the urine comes out. Radical total cystectomy + urinary diversion is one of the most complex surgical procedures in urology, accompanied by a high rate of surgery-related complications (about 40-50%) and is so traumatic for the patient that some patients even need a second surgery to recover. Different urinary diversion schemes also clearly affect the complications of the procedure, and now we look at several common diversion schemes and their applicability. 1, ureterosigmoid anastomosis This procedure is the oldest urinary diversion scheme, which has been continuously improved and perfected, and various procedures such as Mainz II have been derived. However, all of them follow similar treatment principles, in which the sigmoid colon or rectum is transformed into a spherical or capsular shape and then the ureter is anastomosed to it. This procedure is easy to perform, less invasive, and allows the patient to use the anal sphincter to control stool and urine. However, there are two major disadvantages of this procedure: fecal contamination of the ureter, which leads to recurrent infections; the urine-fecal mixture increases the risk of intestinal tumors. 2.Ileal catheterization is the most widely used and most mature urinary diversion procedure. The urine is exported from the abdominal wall through a section of ileum (about 12 cm) and collected in a urine collection bag. Because this procedure has fewer late complications, care is relatively simple. However, it cannot control urination by itself and requires long-term stoma care and regular replacement of the stoma bag. 3.In-situ neocystoplasty is the most studied urinary flow diversion procedure. The ideal in situ neobladder is to use intestinal sutures to close the new bladder and then anastomose it with the urethra, which can effectively control urination. However, the reality is that there are still some patients in the clinic who have difficulty in controlling urination effectively after surgery, and the mucus secreted by the intestine often blocks the urethra for 3 months after surgery; in the long term, it tends to lead to hydronephrosis and affects renal function. In addition, those with high risk of urethral recurrence or invasion are not suitable for this procedure, and the effect of postoperative urinary control is poorer in women than in men. 4.Subcutaneous urinary storage sac A cystic structure is sewn with intestinal tubes and placed under the skin, with the opening in the skin, which can control urine from flowing out by itself. However, it requires regular sterile catheterization to drain the urine. Higher medical skills are required for the patient. 5.Ureteral skin stoma The ureter is placed directly on the surface of the skin to draw urine out. The biggest benefit of this procedure is that there is no need to disturb the intestinal tube, and the procedure is simple with fewer complications and quicker recovery. However, ureteral skin stoma requires stoma care as well as ileal conduits, and the stoma is associated with more distant off complications, such as strictures and infections. Although the preference and specifics of urinary diversion vary from one medical center to another, the general types and basic principles are derived from the above-mentioned diversions. There is a common desire for a diversion approach that meets quality of life needs, is easy to care for, and has fewer complications and is relatively safe. This is related to the experience of the surgeon, the needs of the patient, the financial situation, and the prognosis of the condition. Patients undergoing a total cystectomy need to take into account their situation and their doctor’s recommendations to choose a diversion method that is right for them and to avoid as much postoperative hassle as possible related to the procedure.