Urinary Diversion Surgery Health Article

Definition

A urinary diversion involves removal of the urinary bladder and adjacent tissues and organs, and re-routing of the urinary stream. This may involve creation of an artificial opening in the abdomen called an ostomy.

Purpose

A urinary diversion is created as a means to treat cancer of the bladder, when conservative measures have been unsuccessful, or when there is recurrence of the disease invading the muscle wall. Congenital deformities or traumatic injury may also necessitate formation of a urinary diversion.

Description

Under general anesthesia, an incision is made in the abdomen. The ureters (tubes that carry urine away from the kidneys) are cut and tied. The bladder and surrounding tissues are cut free and removed. The ureters are then attached to a portion of the intestine. The most common types of urinary diversion are:

• Ileal conduit. Ureters are attached to a portion of the small intestine, the ileum, one end of which is brought through the abdominal wall as a conduit for the urine, creating a stoma.
• Ureterosigmoidostomy. The ureters are attached to a portion of the large intestine, the sigmoid, which allows the urine to flow through the large intestine and out through the rectum.
• Cutaneous ureterostomy. Bringing the detached ureters through the abdominal wall and attaching it to an opening in the skin.

Following creation of an artificial opening to drain the urine, ureteral stents (tubes that go through the stoma and up into the ureters) are often inserted and left in place to allow urine to drain freely from the kidneys, without risk of blockage from swelling due to surgery. The muscles are replaced and sewn together. A transparent pouch is applied to the abdomen to collect urine, and attached to a bedside drainage bag. The incision is closed with sutures or clips ("staples"), which are usually removed about 1 week after surgery.

An alternative to a conventional urinary diversion is the continent urinary diversion. In this surgical procedure, a "false bladder" is constructed within the abdomen, using several lengths of small or large intestine. The ureters are sewn to this new reservoir for urine and nipple valves are created at two sites; the abdominal wall for continence; and where the ureters are implanted, to prevent reflux of urine back to the kidneys. The patient is then taught to catheterize the reservoir to drain urine at regular intervals during the day. Although a continent diversion is not suitable for every patient who requires urinary diversion, it is an option to be considered.