BACKGROUND: Few data are available in comparing different incontinent urinary diversions (ICUD). OBJECTIVE: To compare early, short-term, and long-term complications in three different forms of ICUD. DESIGN, SETTING, AND PARTICIPANTS: 130 high-risk patients undergoing radical cystectomy and ICUD were prospectively enrolled at one institution. The patients were divided into three groups: ileal conduit (IC), colon conduit (CC), and ureteroureterocutaneostomy (UUCS). INTERVENTION: All patients underwent radical cystectomy and one form of ICUD. MEASUREMENTS: The complications observed were prospectively listed and subsequently compared. Statistical analysis was performed using the Pearson's chi-square test. A p-value ≤ 0.05 was considered statistically significant. RESULTS AND LIMITATIONS: 130 patients with a median age of 71.0 yr (range 46–81) underwent radical cystoprostatectomy (RCP): n=95 (73%) or anterior pelvic exenteration (APE) n=35 (27%) with lymphadenectomy. An IC was performed in 55, a CC in 34, and a UUCS in 41 patients, respectively. A high comorbidity, mainly diabetes, arteriosclerosis, pulmonary insufficiency, and borderline renal function (creatinine>1.5mg%) was found in 12.7% of group 1, in 35.2% of group 2, and in 48.9% of group 3. Overall median follow-up was 16 mo (range 5–84). Perioperative mortality occurred in 1.5%. The overall perioperative diversion-unrelated complication rate was 23.6%. IC showed the lowest rate with 18.1%, followed by CC with 26.4%, and UUCS with 32%, respectively. In contrast, major diversion-related complications occurred in 18.1% of IC, in 5.8% of CC, and none in UUCS. The same was true for late surgical reintervention, with 20% for IC, 5.8% for CC, and 2.4% for UUCS. CONCLUSIONS: Complications are closely related to the method selected. The IC had the highest rate of severe complications as well as surgical reinterventions and late complications in the intestinal tract.