Reconstructive Urology & Men's Health
Urostomy - Urinary Diversion
Procedures to either replace the bladder or help the bladder hold urine are called urinary diversions. Urinary diversion can be as simple as using a small part of the bowel as a tube for the urine to travel in as a conduit to an opening in the skin (an ileal conduit or a urostomy) to something more complex that will hold a larger amount of urine. University Health Care urologists can advise you on the best way to deal with bladder problems that might need a urinary diversion. They can also expertly perform these complicated procedures.
Who needs urinary diversion?
Urinary diversion is generally used when the bladder has severe dysfunction or needs to be removed due to cancer. Some of the conditions that can lead to a neurogenic or dysfunctional bladder are spinal cord injury, radiation damage, neurologic diseases and bladder or rectal cancer. Sometimes bowel can be used to expand the volume of the bladder (augmentation cystoplasty) and sometimes the bladder can no longer be used and a urinary diversion can be performed.
What are the different types of urinary diversion?
Urostomy or ileal conduit: The simplest type of urinary diversion is called an ileal conduit or a urostomy. In this type of diversion a short segment of bowel is separated from the gastrointestinal (GI) tract. The urinary tubes from the kidney (ureters) are connected to the abdominal side of this segment of bowel, and the other end of the bowel is brought out of the skin creating a stoma. The stoma sits above the skin and urine drains out of the stoma to a bag, which is pasted to the skin around the stoma. The stoma bags are drained when they fill a few times a day. The urinary stoma bags typically stay on the skin about 3–4 days. This type of urinary diversion takes the least amount of time to create and is probably the most reliable. The downside is that patients have to have a stoma and a bag attached to the skin, and there is a risk of hernias developing around the stoma site.
Neo-bladder: A neo-bladder is when a long segment of usually small bowel is opened and fashioned into a sphere. The urinary tubes from the kidney (ureters) are connected to this sphere and then the new or neo-bladder is sewn to the urethra in the pelvis. A catheter is left in the urethra until healing occurs. Once the catheter is removed the patient voids mostly by relaxation of the urethra sphincter and pushing with their abdominal muscles. The major problem with this type of urinary diversion is incontinence at night due to sphincter relaxation and inadequate emptying of the neo-bladder. Some patients need to perform catheterization every day to drain out residual urine from the neo-bladder. The majority of patients that undergo this type of urinary diversion are having their bladder removed for bladder cancer. This type of diversion is usually not suitable for patients who need urinary diversion from a neurogenic bladder.
Right colon pouch/"Indiana pouch": In a right colon pouch, a large piece of the colon is opened up and fashioned into a sphere. The urinary tubes from the kidneys are attached to this sphere and a then a narrow tube of bowel is brought from the sphere to the skin. This narrow tube of bowel can be brought to the right, lower portion of the abdomen or to the belly button. The narrow lumen of the bowel leading to the stoma and a natural valve in the bowel prevent urinary leakage from the new urinary reservoir. Because this stoma does not leak urine, no external stoma bag is needed. Instead, the patient catheterizes through the small stoma into the new reservoir when it needs to be drained. The typical volume of a right colon pouch is 500–700 ml, and patients need to catheterize about 4–5 times a day. The problems associated with these pouches are scarring of the catheterizable channel and occasional serious complications like perforation of the pouch into the abdomen.