An ileal conduit is a surgical procedure that creates a new pathway for urine to exit the body when the bladder is no longer able to function normally or has been removed. It represents a common type of urinary diversion, allowing individuals to continue managing their urinary output.
Understanding the Ileal Conduit
An ileal conduit is a specific type of urostomy, which is a surgically created opening on the abdomen for urine to pass through. It involves using a segment of the small intestine, specifically the ileum, to form a channel for urine. This isolated piece of ileum acts as a conduit, meaning a passageway, for urine to flow continuously.
The key components of an ileal conduit include the isolated segment of ileum, the ureters, and the stoma. The ureters, which are tubes that carry urine from the kidneys, are connected to one end of this ileal segment. The other end of the ileal segment is brought out through the abdominal wall, creating an opening called a stoma. Urine then drains from the stoma into an external collection pouch worn on the abdomen.
Reasons for an Ileal Conduit
An ileal conduit becomes necessary when the bladder can no longer effectively store or eliminate urine, or when it needs to be removed entirely. The most common reason for this procedure is bladder cancer, particularly when a radical cystectomy (bladder removal) is required.
Other conditions can necessitate an ileal conduit. These include severe bladder dysfunction, such as neurogenic bladder, where nerve damage prevents proper bladder control. Chronic inflammatory conditions like severe interstitial cystitis, which causes persistent bladder pain and dysfunction, may also lead to this surgical intervention. Bladder trauma or congenital abnormalities of the urinary tract are additional circumstances that might require an ileal conduit.
The Surgical Procedure and Function
The creation of an ileal conduit is typically performed during the same surgery that involves bladder removal. The process begins with isolating a short segment of the ileum, usually about 15-20 centimeters long, while preserving its blood supply. The remaining ends of the small intestine are then reconnected to maintain normal digestive function.
Next, the ureters, which transport urine from the kidneys, are detached from the bladder and surgically connected to one end of the isolated ileal segment. This connection allows urine to flow directly from the kidneys into the newly formed conduit. The other end of the ileal segment is then brought through a small opening created in the abdominal wall, forming the stoma. This stoma is typically located on the right side of the abdomen.
Once the ileal conduit is established, urine continuously flows from the kidneys, through the ureters, into the ileal segment, and then out through the stoma. The ileal conduit does not function as a new bladder; it does not store urine. Instead, it acts as a passive channel, directing urine into an external collection pouch that adheres to the skin around the stoma. This prevents urine from backing up towards the kidneys.
Living with an Ileal Conduit
Adjusting to life with an ileal conduit involves learning to manage the stoma and the external collection pouch. Stoma care includes regularly cleaning the skin around the stoma and ensuring a proper fit for the pouching system to prevent skin irritation. The stoma itself is a reddish, moist opening that has no nerve endings, so it is not painful to touch.
Pouch management is a regular part of daily life; the urostomy bag needs to be emptied every few hours, and the entire system typically changed every few days. Patients learn to do this independently, often with guidance from an ostomy nurse. While some individuals may experience issues like skin irritation around the stoma or odor concerns, these can often be managed with proper care and suitable supplies.
Lifestyle adjustments are manageable, and many individuals with an ileal conduit lead active lives. Most people can wear their usual clothing once healed from surgery. Staying well-hydrated is important, and there are no strict dietary restrictions. Physical activity, including swimming and exercise, is possible with appropriate stoma support. Travel also remains feasible with some extra planning, such as packing double the usual supply of ostomy products.
Psychological adjustment is also a consideration, as adapting to changes in body image and daily routine can be a process. Support from healthcare professionals and support groups can be beneficial during this transition. While initial challenges exist, many patients report improved quality of life after the procedure, especially if it resolves previous debilitating urinary symptoms.