An ileal conduit is a specific surgical technique that falls under the broader category of a urostomy. A urostomy is a type of urinary diversion, an operation necessary when the bladder is removed or can no longer safely store and pass urine. The ileal conduit is the most common method used to create a new path for urine to exit the body. This article clarifies the distinction between the two terms and explains the technical details and daily reality of the procedure.
Defining the Urostomy
A urostomy is a surgical opening, or stoma, created on the abdomen to allow urine to drain continuously after the bladder’s function has been compromised or the organ has been removed. This procedure is a form of incontinent urinary diversion, meaning the patient does not have voluntary control over when the urine exits the body. The goal is to reroute the flow of urine from the kidneys, through the ureters, and out of the body via a route other than the urethra. This new path prevents urine from pooling, which protects the upper urinary tract, specifically the kidneys, from pressure damage and infection. The resulting stoma is the reddish, moist, external opening of the diversion, created from a small portion of the intestine brought through the abdominal wall. Since it does not have nerve endings, the stoma itself is not a source of pain.
Understanding the Ileal Conduit Procedure
The ileal conduit utilizes a segment of the small intestine, known as the ileum, to construct the urinary passageway. During the procedure, a surgeon isolates a small section of the ileum, typically 15 to 20 centimeters long, while preserving its blood supply. The remaining ends of the ileum are then rejoined to maintain normal digestive tract continuity. The ureters, which transport urine from the kidneys, are detached from the bladder and surgically connected to one end of this isolated ileal segment. The other end of the ileal segment is brought out through an opening in the abdominal wall, forming the stoma. This intestinal segment acts as a passive channel, or conduit, for urine to flow directly to the exterior of the body. Because the ileum naturally produces mucus, a thick, white mucus will be present in the urine collected through the stoma, which is a normal and expected physiological process.
Medical Conditions Requiring Urinary Diversion
The primary reason for creating an ileal conduit is the necessity for a radical cystectomy, which is the surgical removal of the bladder. The most common indication is muscle-invasive bladder cancer, where the malignancy has penetrated the deeper layers of the bladder wall. Patients with high-grade, non-muscle-invasive bladder cancer that has failed less aggressive treatments may also require this procedure. Chronic conditions that severely damage the bladder or pelvic area can also necessitate a urinary diversion.
Indications for Urinary Diversion
The ileal conduit may be required for several conditions:
- Muscle-invasive bladder cancer.
- High-grade, non-muscle-invasive bladder cancer unresponsive to treatment.
- Severe radiation injury to the bladder.
- Congenital defects of the urinary tract.
- Neurogenic bladder dysfunction, where nerve damage prevents proper bladder function.
The ileal conduit is often preferred over other continent diversions for patients with compromised kidney function or those who are older, as the procedure is technically simpler and carries a lower risk of long-term metabolic complications.
Managing Life with a Stoma
Living with an ileal conduit requires the continuous use of an external ostomy appliance, or pouching system, to collect the draining urine. The appliance consists of an adhesive skin barrier, or wafer, which adheres to the skin around the stoma, and a collection pouch that attaches to the barrier. The skin barrier protects the surrounding skin from constant urine exposure, which could otherwise cause irritation and breakdown. The pouch has a drainage tap or valve at the bottom, allowing urine to be emptied into a toilet several times daily, typically when the pouch is one-third to one-half full. For nighttime management, the pouch can be connected to a larger drainage bag using an adaptor, ensuring continuous drainage while the patient sleeps. Proper stoma care involves routinely changing the entire pouching system, typically every three to five days, and cleaning the skin around the stoma with warm water during the change. Maintaining a tight seal between the skin barrier and the abdomen is necessary to prevent leakage and protect skin integrity.