What are the types of urinary diversion procedures?
Urinary diversion can either be incontinent or continent. Both methods involve using a piece of your intestines to divert urine.
- Incontinent: An incontinent urinary diversion involves creating an opening in your abdomen for pee to come out of. Surgeons do this by connecting your ureters to a piece of your intestine that they bring out through your belly (ostomy or stoma). Pee collects into a bag called an ostomy bag, which you empty. This is sometimes called an incontinent diversion or urostomy.
- Continent: A continent urinary diversion involves making a pouch inside your body from your intestines. This might be in the form of a “neobladder” that connects to your urethra, or with an Indiana pouch that collects urine inside your body that you drain by passing a catheter into a stoma at your belly button.
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Within each type of urinary diversion are several different methods your surgeon can use. The type of urinary diversion you have depends on factors such as your age, medical conditions and health history.
Incontinent urinary diversion
The main type of incontinent urinary diversion is an ileal conduit. You don’t control urination with this type of urinary diversion — it automatically goes into a bag.
Ileal conduit
An Ileal conduit urinary diversion is the most common incontinent urinary diversion method. In an ileal conduit diversion, your ureters are attached to a part of your intestines that’s separate from the rest of your bowels, which is then brought up through your belly wall as a stoma. This automatically directs your pee through the stoma and into an external collection bag that you must empty every few hours.
The advantages of the ileal conduit urinary diversion surgery are:
- It’s a more straightforward procedure compared to other methods.
- There’s no need for self-catheterization (using a tube to drain your own pee).
The disadvantages of the ileal conduit urinary diversion are:
- People may feel self-conscious about having a bag that collects their pee.
- There’s a chance the bag can leak pee and cause an odor.
Continent urinary diversion
A continent urinary diversion gives you more control over urination. It involves either a surgeon creating an internal pouch or making a new (neobladder) bladder to hold your pee.
Indiana pouch reservoir (continent cutaneous reservoir)
An Indiana pouch is made from portions of your intestines. A surgeon cuts your ureters and sews them into this pouch. A short piece of small intestine connected to this pouch is then narrowed to form a channel and brought out through a stoma, often at the belly button. The stoma is smaller than an ileal conduit stoma and doesn’t drain spontaneously. It stores your pee until you drain it via a catheter you place in your stoma. There are different types of pouches a surgeon may create, but an Indiana pouch is the most common.
Unlike the incontinent diversion, no external bag is necessary. Instead, a one-way valve is surgically created to keep your pee inside the pouch. Several times a day (usually every four hours), you insert a small, thin catheter into the stoma and into the pouch to drain your pee. You’ll also have to flush the pouch regularly to clear any mucus that might build up inside.
Most insurance policies will allow you to have enough catheters so that you can use a new one each time. If your policy doesn’t, or if you run out, catheters can be washed with soap and water and reused.
The advantages of the continent cutaneous reservoir method are:
- Your pee is kept inside your body. You don’t need to wear a bag under your clothes.
- Because there’s no bag, the risk of leaking pee is smaller and there’s no potential for odors.
- You can cover your stoma with an adhesive bandage.
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The disadvantages of the continent cutaneous reservoir method are:
- The surgery takes longer compared to incontinent urinary diversion.
- There’s the need for catheterization (placing a small tube into the stoma to empty the pouch), every four hours around the clock.
- Channel complications are common. The channel can leak or develop scar tissue, and a buildup of mucus in the pouch can cause stones and recurrent infections. If you can’t pass a catheter to drain the pouch, it can burst (this is an emergency).
Neobladder or bladder substitute
This procedure most closely resembles the usual function of your bladder and involves creating a replacement or new bladder. A portion of your small intestine is made into a new bladder, which your surgeons connect to your urethra. Pee passes from your kidneys to your ureters and into the pouch (new bladder), and through your urethra, just like it would with a typical bladder. To empty the neobladder, you need to contract (tighten) your abdominal muscles.
To be a candidate for this surgery, there must be a low risk of cancer recurrence (return) in your urethra, and you can’t have any scar tissue or blockage of your urethra Additionally, some people can’t empty the neobladder by contracting their abdominals. In these cases, they must pass a catheter into the urethra to empty the pouch up to six times a day.
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The advantages of the neobladder diversion are:
- The process of urination most closely matches normal urination.
- There’s no stoma to care for.
The disadvantages of the neobladder diversion are:
- Surgery time is usually longer.
- Urinary incontinence (leaking pee) is normal after surgery and might last up to six months. About 20% of people with this type of diversion have incontinence during the night. Up to 10% of people have incontinence during the day and must wear pads to catch leaking pee.
- Some people may never be able to fully empty their new bladders and will still need to perform catheterization (either temporarily or permanently).
Is urostomy the same as urinary diversion?
A urostomy is a type of incontinent urinary diversion. A urostomy is when a surgeon makes an opening in your abdominal wall so that pee can pass through. The pee goes into a bag you wear under your clothes (ostomy bag).