A simple end-to-side freely refluxing ureteroenteric anastomosis into an afferent limb of a low-pressure orthotopic reconstruction, with regular voiding and close follow-up evaluation, is the procedure with the lowest overall complication rate. Continued peristalsis in the afferent ileal limb reduces but does not eliminate reflux. The potential benefit of "conventional" antireflux procedures in combination with orthotopic reconstruction seems outweighed by the higher complication and associated reoperation rates. There are no clear answers to the question of which is the better technique at present, however, and long-term randomized, prospective studies comparing the refluxing and nonrefluxing techniques are warranted.
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