A urinary conduit is a surgically created pathway that redirects urine from the kidneys to exit the body when the bladder can no longer function normally. This procedure, also known as an ileal conduit or urostomy, provides an alternative route for urine flow. Its purpose is to divert urine safely, preventing it from backing up into the kidneys and causing damage. This surgical intervention is a permanent change.
Why a Urinary Conduit is Created
A urinary conduit is created when the bladder cannot store or pass urine normally, or when it needs to be removed. The most common reason is bladder cancer, especially when the entire bladder is surgically removed in a cystectomy. Without the bladder, a new method for urine collection and expulsion becomes necessary.
Other conditions necessitating a urinary conduit include severe bladder dysfunction from neurological disorders like spina bifida or multiple sclerosis, or damage from radiation therapy. Chronic bladder infections, severe urinary tract trauma, or certain birth defects can also lead to this diversion. This procedure is often considered for older patients or those with other health issues, as it can offer fewer risks than other urinary diversion options.
How a Urinary Conduit Functions
A urinary conduit involves using a segment of the small intestine, the ileum, to form a new pathway for urine. During surgery, a section of the ileum is removed from the digestive tract, and the remaining ends are reconnected to maintain normal digestive function. The ureters, which carry urine from the kidneys, are then attached to one end of this isolated ileum segment.
The other end of the intestinal segment is brought through a small opening in the abdominal wall, forming a stoma. Urine flows continuously from the kidneys, through the ureters, into this intestinal conduit, and then exits the body via the stoma. Since the stoma lacks muscles to control urine flow and nerve endings, it does not hurt, and urine drains constantly into an external collection pouch worn on the abdomen.
Living with a Urinary Conduit
Living with a urinary conduit requires adjusting to a new routine for managing urine output. A pouching system, including an adhesive skin barrier and a collection bag, is worn over the stoma to collect the continuously draining urine. This pouch needs to be emptied multiple times daily, typically when it is about one-third full, to maintain comfort.
Routine care of the stoma and appliance is important for preventing skin irritation and complications like infection. The skin around the stoma should be gently cleaned when changing the pouch, which is usually done in the morning before eating or drinking to minimize urine flow. The stoma may appear red and can bleed slightly, similar to gums when brushing teeth, and it may also produce mucus, which is a normal byproduct from the intestinal segment.
Most individuals with a urinary conduit can maintain activities like exercise and swimming with proper pouch management. Wearing comfortable clothing that accommodates the pouch is possible. It is important to monitor for signs requiring medical attention, such as cloudy, foul-smelling, or bloody urine, lower back pain, or persistent leakage, as these could indicate a urinary tract infection or other issues.