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Urinary
Reconstruction and Diversion
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What is urinary reconstruction and diversion?
When the urinary bladder is removed (due to cancer, other medical
condition, or because the organ no longer works), another method
must be devised for urine to exit the body. Urinary reconstruction
and diversion is a surgical method to create a new way for you to
pass urine. |
Urinary diversion options
There are three main types of urinary diversion surgeries:
- Ileal Conduit Urinary Diversion
- Indiana Pouch Reservoir
- Neobladder to Urethra Diversion
For all of these procedures, a portion of the small and/or
large bowel is disconnected from the fecal stream and used for
reconstruction. |
Ileal Conduit Urinary Diversion
With this procedure, the ureters drain freely into part of the
ileum (the last segment of the small intestine). The end of the
ileum into which the ureters drain is then brought out through an
opening in the abdominal wall. This opening, called a stoma, is
covered with a bag that gathers the urine as it drains from the
ileal conduit. |
Advantages: The advantages of the Ileal Conduit Urinary
Diversion surgery are:
- It is a relatively simple surgery.
- It requires less surgical time (compared with other surgical
methods).
- There is no need for occasional catheterization (use of a
tube to drain the urine)
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Disadvantages: The disadvantages of the Ileal Conduit
Urinary Diversion are:
- There is a change in body image.
- It uses an external bag to collect urine, which might leak or
have odors.
- Urine could back up into the kidneys, causing infections,
stone formation in some patients, and organ damage over time.
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Indiana Pouch Reservoir
With this type of surgery, a reservoir or pouch is made out of a
portion of the large intestine (the ascending colon on the right
side of the abdomen) and a portion of the ileum (the last segment of
the small intestine). The ureters are repositioned to drain into
this pouch. The urine flows freely in a downward direction from the
kidneys into the pouch. This positioning prevents urine from backing
up into the kidneys, which protects the kidneys from infection. A
short piece of small intestine is then brought out through a small
opening in the abdominal wall (a stoma). Unlike the Ileal Conduit,
no external bag is needed, and the stoma is very small and can be
covered with an adhesive bandage. Instead, a one-way valve is
surgically created to keep the urine inside the pouch. Several times
a day, usually every four to six hours, a small, thin catheter must
be passed through the stoma and into the pouch to empty the urine.
An adhesive bandage is worn over the stoma at all other times (when
not actively emptying the pouch). Catheters are washed with soap and
water after each use. The catheters do not have to be sterilized.
They can be taken on trips or social events and simply stored in a
zip lock bag. |
Advantages: The advantages of the Indiana Pouch
Reservoir surgery are:
- Urine is kept inside the body, in the reservoir, until it is
ready to be emptied
- No external bag is necessary.
- There is no odor.
- The risk of urine leaking is minimal.
- The small stoma can be covered with an adhesive bandage.
- The risk of reflux (back up) of urine into the kidneys is
lessened, lowering the risk of infection.
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Disadvantages: The disadvantages of the Indiana Pouch
are:
- The surgical time is longer compared with the Ileal Conduit.
- There is the need for occasional catheterization (the passing
of tubing into the stoma to empty the pouch), every four to six
hours.
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Neobladder to Urethra Diversion
This procedure most closely mimics the storage function of a
urinary bladder. With this procedure, a small part of the small
intestine is made into a reservoir or pouch, which is connected to
the urethra. The ureters are repositioned to drain into this pouch.
As with the Indiana Pouch, this downward flow of urine from the
kidneys into the pouch helps prevent urine back up, which helps
protect the kidneys from infection. Urine is able to pass from the
kidney, to the ureters, to the pouch, and through the urethra in a
manner similar to the normal passing of urine. To be a candidate for
this surgical procedure, there must be a low risk of cancer
recurrence in the urethra, and patients must be able to pass a
catheter into the urethra to empty the pouch if necessary. |
Advantages: The advantages of the Neobladder to Urethra
Diversion are:
- The process of urination most closely matches normal
urination.
- No stoma is needed.
- The kidneys are protected from urine back up and infection.
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Disadvantages: The disadvantages of the Neobladder to
Urethra Diversion are:
- Surgery time is slightly longer than the Ileal Conduit
Urinary Diversion procedure.
- Urinary incontinence (leakage of urine) is normal after
surgery — while regaining control of urination — but
might last up to six months. Also, about 20 percent of patients
during the night and 5 percent to 10 percent of patients during
the day are incontinent, requiring the wearing of a pad.
- Despite the surgery, some patients might not be able to empty
their bladder well and will need to perform occasional
catheterization (passing tubing through the urethra into the
pouch every four to six hours) for a prolonged period of time
after surgery and perhaps permanently.
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