Objective To study the results of transverse colon conduit urinary diversion in patients receiving very high dose pelvic irradiation (≥ 65 Gy).Patients and methods Records were reviewed for 30 such patients who underwent transverse colon conduit as a primary form of urinary diversion between January 1986 and June 1992. Most of the conduits were constructed using refluxing ureterocolic anastomoses with stents.Results There was no operative mortality. Although the procedure was associated with a complication rate of 37% and a re‐operation rate of 20%, there were no bowel or urinary anastomotic leaks. The operation could be safely performed on patients with renal failure, with 83% of such patients showing normal or improved serum creatinine levels post‐operatively.Conclusion The advantages of transverse colon conduit urinary diversion are the use of non‐irradiated bowel and ureters for diversion. We recommend it as a primary form of urinary diversion in these high ris