Long-term survival occurs following both ureterosigmoid and ileal diversions. Both manoeuvres carry a significant complication rate but where patients have good rectal continence, ureterosigmoid diversion offers the advantage of appliance free life. Success depends on initial good renal function and successful implantation of the ureters into bowel avoiding both reflux and stenosis. Where there is a likelihood of long survival as in such conditions as ectopia vesicae, this technique will provide very satisfactory management and three patients surviving more than a total of 100 years illustrate this approach.