Urinary diversion is an integral part of any surgical procedure that entails removal of the bladder for treatment of cancer, congenital anomalies, and/or irreparable bladder damage. To obviate the significant functional loss and problems associated with appliance-requiring urinary diversion, there is a current interest on behalf of urologists to explore procedures aiming for creation of sphincter-controlled bladder substitutes. Furthermore, there is an increase in patient’s demand for a more socially and psychologically acceptable forms of urinary diversion. Anal sphincter-controlled urinary diversion is the only continent form without appliance or external stoma that can be utilized if the patient is not a candidate for orthotopic urinary diversion. Ureterosigmoidostomy is the oldest form of urinary diversion but its drawbacks are well known. Nighttime incontinence is common (44%), as are electrolyte abnormalities due to absorption of solutes by the colonic mucosa. In addition, 57% of patients suffered from serious upper tract damage with time due to chronic infection, reflux, and/or obstruction. Finally, the incidence of late adenocarcinoma occurring at the ureterosigmoid anastomosis is estimated to be 3.5–13.3%. It seems that the price the patient pays in terms of incontinence and upper tract deterioration is to high to make this type of diversion acceptable to them or to most of urologists. Mainz II pouch was done to overcome the drawbacks of the classic ureterosigmoidostomy and despite improvement in the results of continence rate, and upper tract and urodynamic study; it is not suitable for cases with moderate or severely dilated ureters. A new surgical procedure in which a pouch was reconstructed of a W-shaped detubularized sigmoid, which must be long enough, in continuity with the colon and rectum to decrease the intra-colonic pressure around the ureters and to increase the compliance of the pouch aiming to improve continence that is provided by the anal sphincter, to improve electrolyte abnormalities, and to preserve the upper tract. Either one or both dilated ureters are re-implanted into the pouch using serous–lined extramural tunnel technique where the length of the tunnel is determined according to the diameter of the dilated ureter to prevent reflux. The early clinical results of this procedure were encouraging. But, as the operation involves utilization of some new concepts, larger number of cases and longer follow-up are needed to confirm its validity. The aim of our study is to assess the quality of this type of urinary diversion in 9 patients (7 males and 2 females), and to assess its effects on the continence rate, upper urinary tract, serum electrolytes, and acid–base balance on long run through its comparison with ureterosigmoidostomy that done in16 patients (11 males and 5 females), and with Mainz II pouch that done in 30 patients (22 males and 8 females), as regard biochemical, radiological and urodynamic changes. Continence rates were nearly the same in both W-sigmoid and Mainz II pouches (100% and 86%, respectively) with 4-5 and 4-6 daytime frequency and 0-2 and 0-3 nighttime frequency, respectively, while it was lower in uretero-sigmoidostomy (78%) with 4-7 daytime frequency and 1-3 nighttime frequency. Most of the enuretic patients responded to Imipramine hydrochloride 50mg orally at night. Hyperchloremic metabolic acidosis was the most common metabolic alteration and occurred in our patients in spite of normal renal function, where it reached up to 57% in W-sigmoid pouch, 66.6% in ureterosigmoidostomy and 52.4% in Mainz II pouch. Most of our patients with hyperchloremic metabolic acidosis were asymptomatic and were advised to take oral alkalinizing agents. It is well observed that metabolic acidosis increased with time of follow- up and it might be due to increased pouch capacity or decreased frequency of evacuation with time. Electrolyte changes in some of our patients occurred in the form of hypocalcemia, hypokalemia, and hypomagnesemia, but with lower incidence rate than metabolic acidosis and minimal difference in 3 groups. Excretory urography provided evidence of ureterocolonic anastomotic stricture in 5.5% of renal units W-sigmoid pouch, in 12% with Mainz II pouch, and in 13.3% with ureterosigmoidostomy. Stone formation is a rare complication, and occurred in only one case of W-sigmoid group. Urodynamic evaluation of the 3 groups revealed that detubularized pouches had adequate capacity and lower pressure than ureterosigmoidostomy with lower incidence of pyelonephritis and incontinence, but no difference in frequency of evacuation between the 3 groups. For the aforementioned results, we concluded that continuing experience with W-sigmoid pouch is the most encouraging, and warrant further utilization of this technique. It seems to be a valid alternative for male or female patients with dilated ureters who don’t want a wet or continent stoma, and they are not candidate for orthotopic urinary diversion.