Urinary diversion is a procedure used to give urine a new way to leave the body. It is necessary when the bladder has been removed because of cancerous tumors or other conditions. It is also performed when a patient’s urinary bladder stops working but is still in the body. Urinary diversion often ends with a patient’s urine exiting the body through the abdominal wall.
One type of urinary diversion is called a non-continent urinary diversion. For this procedure, a surgeon connects the tubes that lead from the kidneys, called ureters, to part of the patient’s intestine. Then, he moves part of the intestine toward the abdominal wall, enabling urine to exit the body through this intestinal segment. With this type of diversion, a patient must wear a special bag, called an ostomy bag, which collects the continuously draining urine.
The non-continent urinary diversion is considered a simple procedure. It requires less time on the operating table than other diversion procedures. After surgery, however, patients may have to deal with odor from the ostomy bag. Some patients may also experience negative changes in how they view their bodies because of the constant presence of the bag.
When a surgeon performs a type of non-continent urinary diversion called the Indiana pouch reservoir, the patient doesn't need an ostomy bag. The surgeon creates a holding pouch using part of the patient’s intestine. He then moves the ureters so they drain into the new pouch. He also moves a small portion of the patient’s small intestine toward a hole in the abdominal wall called a stoma. This provides an exit for the urine.
Instead of dealing with an ostomy bag, the Indiana pouch reservoir patient inserts a thin tube into his abdomen to drain the urine. Since the urine is kept inside the body following surgery, the patient doesn't typically experience any odor or leaking of urine. This surgery lasts longer than the non-continent surgery, which some may view as a disadvantage. After surgery, the patient has to empty his urine about four to six times each day.
Another type of continent urinary diversion is the neobladder continent diversion. To perform this procedure, a surgeon uses a part of the patient’s small intestine to create a pouch. This pouch is then connected to the urethra, the opening through which urine usually leaves the body. Then, the ureters are moved, enabling them to drain urine into the new reservoir.
With a neobladder to urethra diversion, the passing of urine mimics normal body function. There’s no need for a patient to have a stoma with this surgery. This procedure lasts longer than the non-continent procedure, however, and some people experience incontinence after it is complete. Some patients find it difficult to empty the new bladder by straining or using their muscles to urinate. When this problem occurs, patients may use a catheter to empty it periodically.