Ileovesicostomy is a surgical procedure that reroutes the path of urine drainage. It involves using a segment of the small intestine, specifically the ileum, to create a channel that allows urine to exit the body through an opening in the abdominal wall. This procedure provides an alternative method for bladder management when the natural urinary system is compromised.
Understanding Ileovesicostomy
Ileovesicostomy establishes a new way for urine to drain from the bladder. A portion of the ileum is isolated from the digestive tract. This segment is then connected to the bladder, or a remnant of it, creating a conduit. The other end is brought through the abdominal wall to form a stoma, an opening on the skin.
Urine flows from the bladder, through this ileal channel, and out of the body via the stoma. This continuous drainage means the individual will wear an external collection pouch, often called an ostomy bag, over the stoma to gather the urine. This differs from other urinary diversions that might require intermittent catheterization or create a continent reservoir.
Conditions Leading to the Procedure
Ileovesicostomy is performed when the bladder or lower urinary tract is severely damaged, dysfunctional, or diseased, and conservative treatments are insufficient. A common reason for this surgery is neurogenic bladder dysfunction, a condition where nerve problems affect bladder control. This can result from conditions like spinal cord injury, spina bifida, or multiple sclerosis, leading to issues such as incontinence, difficulty emptying the bladder, or high bladder pressures that can harm the kidneys.
The procedure is also considered for individuals who cannot or are unwilling to perform clean intermittent catheterization, a common method for managing neurogenic bladder. It is an option for those with intractable lower urinary tract obstruction or severe congenital anomalies, such as bladder exstrophy, where the bladder is exposed outside the body. In such cases, the surgery aims to provide a low-pressure drainage system, protecting the kidneys from damage caused by urinary retention or high pressures within the bladder. It can also be a solution for patients experiencing complications from other bladder management methods, including recurrent infections or bladder perforation.
The Surgical Process
Ileovesicostomy is a major abdominal surgery performed under general anesthesia. Preparation involves a liquid diet to cleanse the bowels, as a segment of the intestine will be used. A stoma nurse marks the optimal location for the stoma on the abdomen before the procedure.
During the operation, surgeons isolate a segment of the ileum, usually about 10 to 20 centimeters long, while maintaining its blood supply. The remaining ends of the intestine are reconnected to restore digestive tract continuity. The isolated ileal segment is then connected to the dome of the bladder, or a portion of it, creating a wide opening. The other end is brought through an opening in the abdominal wall muscles and skin to form the stoma. This stoma is matured into a “rosebud” configuration.
The surgery can take approximately 3 to 5 hours and may be performed using open surgery or minimally invasive robotic-assisted laparoscopic techniques, which can lead to smaller scars and faster recovery.
Living with an Ileovesicostomy
After an ileovesicostomy, individuals stay in the hospital for about 3 to 7 days. During initial recovery, a temporary tube may be in place to ensure proper drainage and healing of the new channel. Once bowels begin to function, indicated by passing gas, a regular diet can be resumed.
A key aspect of living with an ileovesicostomy is the continuous drainage of urine through the stoma into an external collection pouch, also known as an ostomy bag. This pouch adheres to the skin around the stoma and needs regular emptying. Stoma care involves cleaning the skin around the stoma and changing the adhesive wafer and pouch system every three to seven days, depending on the product and individual needs. Ostomy nurses provide extensive training and support for managing the stoma and maintaining skin health.
With proper care, individuals with an ileovesicostomy can lead full and active lives, including participation in most recreational activities. Long-term follow-up with healthcare providers is important to monitor for potential complications such as stomal stenosis, urinary tract infections, or stone formation.