A urinary diversion bypasses the normal urinary route.
Bladder cancer, trauma, birth defects and disease sometimes result in a patient requiring complete removal of the bladder. In these cases, the body still needs a way to store and eliminate urine. A urinary diversion provides the body with such a mechanism by bypassing the normal urinary pathway. The new route leads to a surgically created opening for the elimination of urine.
There are three types of urinary diversion: neobladder reconstruction, continent diversion, and ileal conduit diversion. Each functions a bit differently and the appropriateness of each type varies from patient to patient.
In neobladder reconstruction, a new bladder is created using tissue from the intestines. The new bladder is then attached to the urethra. With this diversion method, there is no new opening created for the elimination of urine. Urine leaves the body in much the same way that it did before the surgery. After neobladder reconstruction surgery, blood may be seen in the urine. It should disappear over time. Neobladder reconstruction is not appropriate for every patient. Candidates for this type of diversion will be tested for kidney and ureter function, as well as for infection. If the urethra has been removed along with the bladder, neobladder reconstruction is not possible.
Some patients who are ineligible for neobladder reconstruction may benefit from continent diversion instead. During the procedure, a new bladder is created from intestinal tissue. Part of that tissue is then brought to the side of the abdomen, where an opening — called a stoma — facilitates the elimination of urine. A catheter is used to drain urine from the body. Continent diversion is a complex procedure with complex upkeep required on the patient’s behalf. A good candidate will be self-motivated to properly catheterize the bladder and remove excess mucous. Excess mucous in the urine is normal after urinary diversion, and will become less pronounced over time.
A third option is available for patients who are unable to perform the maintenance required with continent diversion. Ileal conduit diversion is the simplest of the diversion types. A piece of the small intestine is used to create a tube that is attached to the ureters. This creates a connection between the kidneys and stoma. Urine continuously flows through the stoma, so an ostomy bag is required for the collection of urine. Ileal conduit diversion carries less risk of long-term complications than the other diversion types. Conduit diversion patients may experience fluid drainage for 6 to 8 weeks after surgery. This drainage should gradually transition from red to pink, becoming brown and ultimately yellow.
What to Expect
Doctors will provide patients with self-care instructions regarding proper catheter use and how to function with a stoma, if applicable. Follow-up appointments will ensure that the diversion is functioning properly and urine is being drained. Patients will also be tested for any electrolyte imbalances. Although the initial adjustment period can be emotionally and physically difficult, most patients eventually resume a normal routine.