An ileal conduit is a specific and common type of urostomy, which is a broader term for any surgical procedure that creates a new pathway for urine to exit the body. A urostomy is necessary when the bladder is removed or cannot function properly, requiring a diversion of the urinary stream. The procedure establishes an opening, known as a stoma, on the abdomen’s surface through which urine drains. The ileal conduit is the most frequently performed method of achieving this urinary diversion.
Urostomy: The Broad Category of Urinary Diversion
Urostomy is an umbrella term for any surgically created opening that redirects urine flow from the kidneys, bypassing the bladder, to an external collection point on the abdominal wall. This procedure is categorized as a urinary diversion, necessary when the natural urinary tract is compromised. The goal is to ensure continuous, low-pressure drainage of urine to protect the kidneys from damage.
Other types of urinary diversion exist, such as continent diversions like an Indiana Pouch or a neobladder, which create an internal reservoir for urine. These alternative methods are more complex and require the patient to periodically empty the internal pouch, often with a catheter. The ileal conduit remains the most widely used technique due to its simplicity and lower rate of long-term complications.
The Ileal Conduit: Mechanism and Construction
The ileal conduit is a non-continent urostomy, meaning that urine drains continuously and requires an external pouch for collection. This procedure involves isolating a small segment of the ileum, the final section of the small intestine, typically six to eight inches long. Surgeons then reconnect the remaining intestine to maintain normal digestive function.
The ureters, which carry urine from the kidneys, are surgically attached to one end of this isolated ileal segment. This segment of bowel acts as a passive channel or “conduit” for urine. The other end is brought out through an incision in the abdominal wall, forming the stoma, which is highly vascular and protrudes slightly from the skin, often on the right side. Urine flows immediately out of the stoma, as this bowel segment does not store urine.
Medical Reasons for Undergoing the Procedure
The creation of an ileal conduit is most often performed in conjunction with a radical cystectomy, the surgical removal of the bladder. The most common reason for a cystectomy is muscle-invasive bladder cancer, or non-muscle-invasive bladder cancer that has not responded to immunotherapy.
Beyond cancer treatment, this diversion may be necessary for severe bladder damage resulting from chronic interstitial cystitis, trauma, or extensive radiation therapy. Certain congenital anomalies or severe neurological conditions, such as neurogenic bladder, can also necessitate the procedure. The ileal conduit is often the preferred option for elderly patients or those with pre-existing kidney issues, as the short bowel segment minimizes metabolic complications.
Daily Management and Care of the Stoma
Since the ileal conduit is a non-continent diversion, a specialized external collection system, known as a urostomy appliance or pouch, must be worn continuously over the stoma. This appliance consists of an adhesive skin barrier, or wafer, that adheres to the skin surrounding the stoma, and a pouch that collects the urine. The stoma looks moist and red, similar to the inside of the mouth, and is not painful to touch as it contains no nerve endings.
The pouch must be emptied several times a day when it is about one-third to half full, typically through a small valve at the bottom. At night, the pouch can be connected to a larger drainage bag for uninterrupted sleep. Maintaining the health of the peristomal skin, the area immediately surrounding the stoma, is important to prevent irritation and leakage.
Proper stoma care involves routinely changing the entire appliance, usually every three to five days, and cleaning the skin with warm water. The size of the opening in the skin barrier must be precisely measured and cut to fit snugly around the stoma, preventing urine from contacting the skin. With guidance from an Ostomy Nurse, most individuals adapt quickly and can return to most normal activities, including exercise and swimming.