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Surgeons-Creating-an-Ileal-Conduit

Urinary diversion is the term for the various surgical options used to create a way for urine to be collected or directed out of the body after bladder removal.

The purpose of the bladder is to hold urine that's produced by the kidneys and send it to through a tube called the urethra to the outside of the body. A series of muscles and nerves allows this process to take place at a controlled pace throughout your day.

If you have bladder cancer or another condition or problem that makes it necessary to remove this important structure, you'll need an alternative way to effectively continue the normal flow of urine.

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Ileal Conduit

An ileal conduit urinary diversion is created with part of the small intestine. The newly created tube allows urine to pass through an opening in the abdominal wall called a stoma to a collection bag. Intestinal tissue is used to allow tubes going from the kidneys to the bladder (ureters) to drain into the last part of the small intestine (ileum). The ileum then goes to the stoma. The urine bag sticks to the skin and is drained as needed. Catheterization isn't necessary with an ileal conduit.

Surgeons-Creating-a-Neobladder-to-Urethra-Diversion
Surgeons-Creating-an-Indiana-Pouch-Reservoir

Neobladder to Urethra Diversion

Small intestine tissue is used to create a sphere-shaped pouch that closely resembles the bladder that was removed with this option. The newly created pouch is placed in the same location as the original bladder that was removed. The neobladder is attached to the ureters coming from the kidneys and to the urethra that exits the body. The neobladder is emptied by contracting abdominal muscles. If it doesn't drain completely, a catheter may need to be used. Patients sometimes need to get a feel for how much pressure to apply with abdominal muscles to empty the neobladder. Urinary incontinence is sometimes experienced with this type of urinary diversion.

Indiana Pouch Reservoir

Also referred to as a continent urinary reservoir, this type of urinary diversion uses part of the intestine to create a pouch where urine can be stored. When the pouch is full, it is drained with a catheter that's inserted thorough a stoma in the abdomen. The pouch is created with part of the large intestine and part of the ileum. During the procedure, the ureters are repositioned to drain directly into the pouch in a way that prevents urine from traveling back into the kidneys. With this option, there is no need for a collection bag, so the stoma can be concealed with a bandage between drainages.

Any type of urinary diversion will result in some changes with urination. For instance, you'll likely see some mucus in your urine since the intestinal tissues used to create the new bladder normally produce mucus and will still do so. With options requiring a stoma or catheter use, you'll have to look for signs of infection or irritation. Follow-up care typically includes exams of your urinary tract and urine testing. If any other issues are suspected, you may have a cystoscopy, or image testing may be done. Most people are able to live healthy, productive lives after urinary diversion surgery.

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faculty_dhar
Mrinal Dhar, M.D.
General Urology
Associate Professor of UCI Department of Urology
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Michael K. Louie, M.D.
General Urology
Associate Clinical Professor & Director of Urology, Inland Empire
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M. Leon Seard, II, M.D.
General Urology
HS Associate Clinical Professor, Director of Ambulatory Urologic Services

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