Tapered terminal ileum and an intact ileocecal valve have been shown to be an effective efferent continence mechanism in patients with continent ileocecal urinary reservoirs. The terminal ileum can be tapered by simple suture plication or with linear gastrointestinal stapling devices. We used precise urodynamic techniques to study 21 continent urinary reservoirs constructed from ileocecal bowel segments: 14 with plicated segments and 7 with stapled segments. Mean contraction pressures tended to be higher in the latter (P = 0.054), although maximum contraction pressures were similar (P = 0.48). Terminal ileum tapered with the gastrointestinal stapling device and an intact ileocecal valve provide for an effective efferent continence mechanism that is easy to construct and catheterize.