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What is urinary reconstruction and diversion?
When the urinary bladder is removed (due to cancer, other medical condition,
or because the organ no longer works), another method must be devised for urine
to exit the body. Urinary reconstruction and diversion is a surgical method to
create a new way for you to pass urine.
Urinary diversion options
There are three main types of urinary diversion surgeries
- Ileal Conduit Urinary Diversion
- Indiana Pouch Reservoir
- Neobladder to Urethra Diversion
For all of these procedures, a portion of the small and/or large bowel is
disconnected from the fecal stream and used for reconstruction.
Ileal Conduit Urinary Diversion
With this procedure, the ureters drain freely into part of the ileum (the
last segment of the small intestine). The end of the ileum into which the
ureters drain is then brought out through an opening in the abdominal wall. This
opening, called a stoma, is covered with a bag that gathers the urine as it
drains from the ileal conduit.
Advantages: The advantages of the ileal conduit urinary diversion surgery
are:
- It is a relatively simple surgery
- Requires less surgical time (compared with other surgical
methods)
- There is no need for occasional catheterization (use of a tube
to drain the urine)
Disadvantages: The disadvantages of the Ileal Conduit are:
- Change in body image
- It uses an external bag to collect urine, which might leak or
have odors
- Urine could back up into the kidneys, causing infections, stone
formation in some patients, and organ damage over time
Indiana Pouch Reservoir
With this type of surgery, a reservoir or pouch is made out of a portion of
the large intestine (the ascending colon on the right side of the abdomen) and a
portion of the ileum (the last segment of the small intestine). The ureters are
repositioned to drain into this pouch. The urine flows freely in a downward
direction from the kidneys into the pouch. This positioning prevents urine from
backing up into the kidneys, which protects the kidneys from infection. A short
piece of small intestine is then brought out through a small opening in the
abdominal wall (a stoma). Unlike the Ileal Conduit, no external bag is needed
and the stoma is very small and can be covered with a bandaid. Instead, a
one-way valve is surgically created to keep the urine inside the pouch. Several
times a day, usually every 4 to 6 hours, a small, thin catheter would need to be
passed through the stoma and into the pouch to empty the urine. A bandaid is
worn over the stoma at all other times (when not actively emptying the pouch).
Catheters are washed with soap and water after each use. The catheters do not
have to be sterilized. They can be taken on trips or social events and simply
stored in a zip lock bag.
Advantages: The advantages of the Indiana Pouch Reservoir surgery are:
- Urine is kept inside the body, in the reservoir, until it is
ready to be emptied
- No external bag is necessary
- There is no odor
- The risk of urine leaking is minimal
- The small stoma can be covered with a bandaid
- The risk of reflux (back up) of urine into the kidneys is
lessened, lowering the risk of infection
Disadvantages: The disadvantages of the Indiana Pouch are:
- The surgical time is longer compared with the Ileal Conduit
- There is the need for occasional catheterization (the passing
of tubing into the stoma to empty the pouch), every 4 to 6 hours
Neobladder to Urethra Diversion
This procedure most closely mimics the storage function of a urinary bladder.
With this procedure, a small part of the small intestine is made into a
reservoir or pouch, which is connected to the urethra. The ureters are
repositioned to drain into this pouch. As with the Indiana Pouch, this downward
flow of urine from the kidneys into the pouch helps prevent urine back up, which
helps protect the kidneys from infection. Urine is able to pass from the kidney,
to the ureters, to the pouch, and through the urethra in a manner similar to the
normal passing of urine. To be a candidate for this surgical procedure, there
must be a low risk of cancer recurrence in the urethra and patients must be able
to pass a catheter into the urethra to empty the pouch if necessary.
Advantages: The advantages of the Neobladder to Urethra Diversion are:
- The process of urination most closely matches normal urination
- No stoma is needed
- The kidneys are protected from urine back up and infection
Disadvantages: The disadvantages of the Neobladder to Urethra Diversion
are:
- Surgery time is slightly longer than the ileal conduit urinary
diversion procedure
- Urinary incontinence (leakage of urine) is normal after surgery
-- while regaining control of urination -- but may last up to 6 months.
Also, approximately 20 percent of patients during the night and 5 to 10
percent of patients during the day are incontinent, requiring the wearing of
a pad.
- Despite the surgery, some patients may not be able to empty
their bladder well and will need to perform occasional catheterization
(passing tubing through the urethra into the pouch every 4 to 6 hours) for a
prolonged period of time after surgery and perhaps permanently.
A Look at the Three Surgical Procedures
Ileal Conduit Urinary Diversion:
A segment of the intestine directs urine through a stoma into an
external collecting bag.
Indiana Pouch Reservoir:
A pouch made out of portions of intestines stores urine until it is
drained via a catheter inserted through the stoma.
Neobladder to Urethra Diversion:
Intestine is made into a reservoir and connected to the urethra.
What can I expect in the immediate post-op period?
It takes 1 to 2 months on average to feel well again and to regain
your strength. Also, it is not unusual to feel a little depressed or
discouraged after surgery. Discussing your feeling with friends, family,
and even other members of a support group (ask your health care team
member about support groups in your area) can help you deal with your
emotions. As with any life change, an adjustment period is normal. Don't
hesitate to call your doctor or other health care team members for
assistance or if you have questions. Their goal for you is to get you
back to your lifestyle as soon as possible.
What restrictions will I face regarding work, activities, diet, or travel?
People with urinary diversions are usually able to return to the life, work,
and hobbies that they previously enjoyed.
Most people can return to their jobs in 1 or 2
months on average. If you have concerns about your line of work or other job
hazards, be sure to ask your doctor.
Activities. After the post-operative period, exercising
and participation in sports and other activities is encouraged. Check with
your doctor or health team member.
Diet. There are no eating restrictions, but if you have
special dietary concerns, check with your doctor or health team member.
Travel. There are no travel restrictions. Just a word to
the wise -- travel fully prepared with necessary supplies, as you may not be
able to purchase all supplies at your destination.
Urinary
Tract Anatomy
The urinary tract consists of two kidneys, two ureters, a urinary bladder, and a urethra. The kidneys filter your blood and remove water and waste through the urine. The urine travels from the kidney to the bladder through tubes called
ureters. The urine is stored in the urinary bladder, and then moves through the urethra to be passed out of the body when you urinate.
When the bladder is removed, urine needs to exit the body in a new way - through a urinary diversion. In all of the various types of urinary diversions, a part of the intestine is surgically converted to either:
Regardless of surgical method, urine and stool remain completely separate from each other (they are two different systems - the urinary and digestive systems, respectively).
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