Urine is a liquid that carries waste from your body. It passes from the kidneys to the urinary bladder through tubes called ureters. From the bladder, it exits the body through a tube called the urethra which opens from the vulva in women and the tip of the penis in men.
When the bladder has to be removed (a procedure called a "cystectomy") because of bladder cancer, for example, the body needs a new way to get rid of urine. The general name for surgeries that create new ways to get rid of urine is "urinary diversion."
All urinary diversion treatments are surgical and involve using healthy parts of the body in new ways to collect urine, taking over the function that the urinary bladder once had.
Today there are multiple approaches to managing bladder removal, described below. These procedures have different side effects and potential complications. Some involve learning new ways to pass urine. Some carry a greater chance of incontinence or later infection.
Your surgeon will help you determine the best treatment option based on your individual case and circumstances.
This procedure involves creating a new bladder using part of the large or small intestine. The surgeon connects the ureters and the urethra to the neobladder so urine can flow into it and out of it as it would a normal bladder and empty from the vulva or penis.
The ileal conduit diversion is easiest urinary diversion to manage, requires the least maintenance, and places the least strain on the kidneys. It involves making a small, closed channel using a section of intestine. The kidneys are connected to that channel, and it, in turn, is connected to a small, permanent opening in the abdomen called a stoma.
Thereafter, patients wear a special urostomy bag over the stoma to hold urine as it leaves the kidneys. There are many different styles of urostomy bag designed to be as discrete and convenient as possible.
As an alternative procedure for some candidates, this approach is like having a large-capacity pouch that stores urine insidethe body. The pouch is again made from part of the intestine, and there is still a small, permanent hole in the abdomen called a stoma.
The stoma is made from bowel and is designed not to leak urine. Instead, the patient inserts a catheter through the stoma to drain urine out of the internal pouch when it gets full (ideally about every four hours).
A continent diversion requires that patients have good manual dexterity to catheterize the pouch and that they pay attention to a regular daily catheterization schedule. Additionally, this diversion requires properly functioning kidneys.