Background: Ureteroenteric strictures (UES) are a frequent complication after urinary diversion, with incidences ranging from 3-10% in open cystectomy and varying in robotic procedures. Real-time indocyanine green (ICG) angiography utilizing the SPY fluorescence imaging platform may mitigate this by assessing ureteral perfusion intraoperatively. Aim: To assess the impact of intraoperative utilization of real-time indocyanine green angiography with the SPY fluorescence imaging platform on the rate of frequency of UES following urinary diversion. Patients and methods: This was a prospective comparative research at the Department of Urology, Faculty of Medicine, Suez Canal University. The research population was the patients who received the SPY-guided perfusion assessment during surgery and the control group of patients who underwent similar procedures without the use of SPY imaging. Results: No significant differences in age, gender, or BMI; significant difference in Charlson Comorbidity Index (p<0.05). Significant reductions in UES rates with SPY (p<0.05), alongside differences in follow-up, diversion types (ileal conduit, orthotopic bladder, Indiana pouch), and surgical approach. Mean ureteral excision: left 0.89 cm, right 0.85 cm. Conclusion: SPY fluorescence angiography significantly lowers UES incidence by ensuring adequate perfusion, supporting its integration in urinary diversion procedures.