Urinary reconstruction and diversion is a surgical method to create a new way to pass urine out of the body after the bladder has been removed.
When your urinary bladder is removed (due to cancer, other medical conditions or because the organ no longer works), you need another way to pass urine through your body (pee). Urinary reconstruction and diversion are types of surgery done to help you do this.
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The urinary tract normally consists of two kidneys, two ureters, a urinary bladder and a urethra:
When the bladder is removed, urine needs to exit the body in a new way, through a urinary diversion. In all of the types of urinary diversions, a part of the intestine is surgically converted to either 1) a passage tube for urine to exit the body, or 2) a reservoir to store urine (like a normal bladder).
Regardless of surgical method, urine and stool remain completely separate from each other. (They are two different systems — the urinary and digestive systems — respectively.)
There are three main types of urinary diversion surgeries:
For all of these procedures, a portion of the small and/or large bowel is disconnected from the fecal stream and used for reconstruction.
A segment of the intestine directs urine through a stoma into an external collecting bag.
With this procedure, the ureters (the tubes that carry urine from the kidneys to the bladder) 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 and disadvantages
The advantages of the ileal conduit urinary diversion surgery are:
The disadvantages of the ileal conduit urinary diversion are:
A pouch is made of portions of the intestines. It stores urine until it is drained via a catheter inserted through the stoma.
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). The stoma is very small and can be covered with an adhesive bandage.
Unlike the ileal conduit, no external bag is needed. Instead, a one-way valve is surgically created to keep the urine inside the pouch. Several times a day (usually every four hours around the clock), a small, thin catheter must be passed through the stoma and into the pouch to empty the urine. An adhesive bandage is worn over the stoma at all other times (when not actively emptying the pouch).
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 catheters don’t have to be sterilized. They can be taken on trips or social events and simply stored in a plastic bag.
Advantages and disadvantages
The advantages of the Indiana pouch reservoir surgery are:
The disadvantages of the Indiana pouch are:
TheIntestine is made into a reservoir and connected to the urethra.
This procedure most closely resembles the storage function of a urinary bladder. 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.
Urine is able to pass from the kidneys, to the ureters, to the pouch, and through the urethra in a manner similar to the normal passing of urine. To empty the pouch, you need to contract (tighten) your abdominal muscle.
To be a candidate for this surgery, there must be a low risk of cancer recurrence (return) in the urethra. Occasionally, people aren’t able to empty adequately by contracting their abdominal muscles. In these cases, they must pass a catheter into the urethra to empty the pouch, up to six times a day. If this isn’t something you’re willing or able to do, you probably shouldn’t consider this type of diversion.
Advantages and disadvantages
The advantages of the neobladder-to-urethra diversion are:
The disadvantages of the neobladder-to-urethra diversion are:
After urinary reconstruction and diversion, it takes one to two months to feel well again and to regain your strength. Don't hesitate to call your doctor or other healthcare 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.
People with urinary diversions are usually able to return to the life, work and hobbies they previously enjoyed:
A note from Cleveland Clinic
As with any life change, an adjustment period is normal after a major surgery. It's not unusual to feel a little depressed or discouraged. Talk about your feelings with friends and family. If you join a support group, other members may be able to help you deal with your emotions. (Ask your healthcare team member about support groups in your area.)
Last reviewed by a Cleveland Clinic medical professional on 09/14/2020.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy