Urinary diversion is a surgical procedure designed to create an alternative pathway for urine to exit the body. This intervention becomes necessary when the bladder can no longer function properly or has been removed due to disease or injury. The goal is to ensure continuous, safe urine drainage, preventing complications from buildup within the urinary system.
Reasons for Urinary Diversion
Several medical conditions or circumstances can necessitate a urinary diversion. Bladder cancer is a common reason, particularly when a radical cystectomy, which is the complete removal of the bladder, is required. Severe bladder dysfunction, often stemming from neurological conditions such as spinal cord injuries, multiple sclerosis, or spina bifida, also frequently leads to this procedure.
Trauma to the urinary tract or severe chronic bladder infections that have caused irreversible damage may also warrant a urinary diversion. Damage from radiation therapy, which can permanently affect bladder function, or chronic urinary retention due to conditions like an enlarged prostate, can make this surgery a necessary option.
Types of Urinary Diversion Procedures
Urinary diversion procedures are broadly categorized into incontinent and continent diversions. The choice of procedure depends on various factors, including the patient’s overall health, manual dexterity, and personal preferences. These techniques often utilize a segment of the intestine to create the new urinary pathway.
Incontinent Diversions
Incontinent urinary diversions create a stoma, an opening on the abdominal wall, through which urine continuously drains into an external collection device. The most common type is the ileal conduit, also referred to as a urostomy.
In this procedure, a surgeon isolates a short segment of the small intestine and connects the ureters (tubes carrying urine from the kidneys) to one end of this segment. The other end of the intestinal segment is then brought through the abdominal wall to form the stoma. Urine flows from the kidneys, through the ureters, into the ileal conduit, and then directly into a pouch worn on the outside of the body. The ileal conduit does not store urine but acts as a passive channel for continuous drainage.
Continent Diversions
Continent urinary diversions are designed to allow for internal urine storage, providing individuals with more control over when they empty their urine. These procedures create an internal pouch or reservoir from a segment of the intestine.
One type is the continent cutaneous reservoir, sometimes called an Indiana pouch. Here, a surgeon uses a piece of the bowel to create an internal pouch within the abdomen. The ureters are connected to this internal reservoir, and a small, valve-like stoma is created. Patients empty this pouch at regular intervals by inserting a thin tube, or catheter, through the stoma into the reservoir. This method eliminates the need for an external collection bag, as urine is stored internally until drained.
Another option is the neobladder, or orthotopic bladder substitute. In this procedure, a new bladder is constructed from a segment of the intestine and placed in the same anatomical location as the original bladder. This new bladder is then connected to the ureters and to the urethra, allowing for a more natural voiding process. While a neobladder aims to mimic normal urination, some individuals may still need to use self-catheterization or apply manual pressure to fully empty the neobladder.
Managing Life with a Urinary Diversion
Adjusting to life with a urinary diversion involves learning new routines for self-care and making certain lifestyle adjustments. Patients receive guidance from healthcare professionals, often specialized ostomy nurses, to ensure a smooth transition. Effective management is important for maintaining overall health and quality of life.
For those with an incontinent diversion, such as an ileal conduit, meticulous ostomy care is important. This includes regularly emptying the external pouch when it is one-third to one-half full to prevent leaks. Changing the pouching system typically occurs every three to seven days, depending on system and needs. Proper skin care around the stoma, including gentle cleaning and ensuring dryness before applying a new barrier, is important to prevent irritation and infection.
Individuals with continent diversions, like a continent cutaneous reservoir or neobladder, learn self-catheterization to empty their internal pouch. This procedure involves inserting a catheter through the stoma or urethra at regular intervals, typically every four to six hours, to drain the stored urine. Maintaining proper hygiene, including hand washing before and after care, is important to minimize the risk of infection.
General health considerations include maintaining adequate hydration, as fluid intake is important for kidney health and to help flush mucus produced by the intestinal segment. Most people can return to their usual activities, including swimming and other exercises, after recovery. However, avoiding heavy lifting or strenuous core activities for several weeks post-surgery is often advised for proper healing. Many find support groups beneficial for sharing experiences and emotional support.
Important Post-Procedure Information
Following urinary diversion surgery, medical follow-up is important for monitoring recovery and ensuring long-term health. Regular check-ups allow healthcare providers to assess the function of the diversion and address any emerging concerns. These appointments are important for personalized care and to optimize procedure success.
Patients should be aware of warning signs that warrant immediate medical attention. These include signs of infection such as fever, unusual pain not managed by prescribed medication, or significant changes in urine output. Other indicators like spreading redness around the stoma, persistent nausea or vomiting, or difficulty inserting a catheter for continent diversions also require prompt medical evaluation. Recognizing these symptoms early can prevent potential complications and ensure timely intervention.
Maintaining overall wellness with a urinary diversion involves adhering to care routines and lifestyle recommendations. This includes proper stoma or catheter care, as well as being mindful of diet and hydration. By following post-operative instructions and communicating with their healthcare team, individuals can manage their urinary diversion effectively and lead fulfilling lives.