Objective To describe the short-term outcomes with the bowel anastomosis (BA) approach vs the no-bowel anastomosis (NBA) approach in adult patients undergoing urinary diversion. Methods A chart review was performed of adults undergoing urinary diversion from 2006 to 2015. Patients with a pre-existing colostomy were divided into NBA and BA groups. Postoperative complications were recorded per the Clavien-Dindo system. Variables were compared using the BA group as a control. A 2-tailed t test was used to compare means. Results A total of 43 patients were included: 33 in the BA group and 10 in the NBA. No significant differences were found between the 2 groups for the comorbidity index (P =.16), the body mass index (P =.54), or radiation history (P =.90). In the NBA and BA groups, the median blood loss was 250 and 300 mL (P =.11); the operative time was 550 and 480 minutes (P =.15); and the length of stay was 10 and 25 days (P =.38), respectively. The BA group had a higher rate of intraoperative (P =.04) and early (P =.02) overall complications. No significant difference was found in early bowel (P =.15) or ureteral obstruction (P =.08), in the overall stomal complications (P =.11), or in the rate of <90-day reoperation (P =.32). Conclusion A lower rate of intraoperative and postoperative complications occurred in patients undergoing conversion of colostomy to a urinary diversion compared with patients with de novo urinary conduit creation. When possible, a BA should be avoided.