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. This reroutes the urinary stream, ensuring continuous drainage from the kidneys. The procedure provides a means for the body to eliminate waste products that would normally be stored in the bladder. It serves as a permanent solution for individuals who have undergone bladder removal or have severe bladder impairment.
Understanding the Ileal Conduit
An ileal conduit is a type of urinary diversion, specifically classified as an incontinent diversion. This means that urine flows continuously and cannot be voluntarily controlled, requiring an external collection device. The procedure isolates a segment of the small intestine (ileum) to form a tube. This segment typically measures 15 to 20 centimeters (about 5.9 to 7.8 inches) in length.
One end of this isolated ileal segment is closed, while the other is brought through the abdominal wall to create a stoma. The stoma serves as the exit point for urine from the body. The ileal conduit does not store urine like a bladder; instead, it provides a continuous drainage system.
Why an Ileal Conduit is Necessary
An ileal conduit becomes necessary when the natural urinary system, particularly the bladder, can no longer effectively store and eliminate urine. This often occurs due to medical conditions or extensive surgical procedures. The most common reason is bladder removal (cystectomy), frequently performed for invasive bladder cancer.
Beyond cancer, severe bladder dysfunction can also necessitate an ileal conduit. Conditions like neurogenic bladder (nerve damage impairing bladder control) or intractable urinary incontinence may lead to this surgery. Chronic inflammatory conditions that severely damage the bladder, or certain birth defects affecting the urinary tract, are other reasons.
How an Ileal Conduit Works
The creation of an ileal conduit involves several surgical steps. A section of the ileum is isolated from the rest of the digestive tract, and the continuity of the remaining intestine is restored.
One end of this isolated segment is sealed. The ureters, which carry urine from the kidneys, are then surgically connected to the unsealed end. This connection allows urine to flow directly from the kidneys into the newly formed conduit.
The open end of the ileal segment is brought through an opening in the abdominal wall, typically on the right side, to create the stoma. Urine continuously flows from the kidneys, through the ureters, into the ileal conduit, and out through the stoma. An external collection pouch is worn over the stoma to gather the urine.
Living with an Ileal Conduit
Adjusting to life with an ileal conduit involves new routines for managing urine drainage. Regular stoma care is important, including cleaning the skin around the stoma to prevent irritation. An ostomy pouching system, consisting of a skin barrier and a collection pouch, is worn over the stoma to collect the continuously flowing urine.
Pouches need to be emptied several times daily, usually when one-third to one-half full. The entire pouching system is changed every 3 to 7 days, though this can vary based on individual output and product type. Maintaining good hygiene, including regular showering, is important.
Most clothing can still be worn, though some individuals opt for looser waistbands or specialized undergarments for comfort. Hydration is important to support kidney function and dilute urine, which helps reduce the risk of urinary tract infections. Patient education and support from healthcare professionals, such as ostomy nurses, are important for successful long-term management.