CCS adapting to COVID-19 realities to support Canadians during and after the pandemic
A urinary diversion is surgery that makes a new way for urine (pee) to leave the body. Urine is your body’s liquid waste. A urinary diversion is done when the normal flow of urine is blocked or the bladder can’t store urine. The most common reason to have a urinary diversion is after the whole bladder is removed for bladder cancer.
A urinary diversion may also be called a urinary tract diversion or bladder diversion.
Why a urinary diversion is done
Urine is made by the kidneys and then travels along 2 long tubes called ureters to the bladder. The urine is pushed out of the bladder through the urethra where it leaves the body. A urinary diversion is done when the urine can’t flow out of the body as usual.
A urinary diversion can be done:
- for bladder cancer when the whole bladder is removed (called a radical cystectomy)
- after pelvic exenteration surgery for some advanced cancers
- to go around a blockage (obstruction) and relieve blocked urine flow
- when there is damage to the bladder from radiation therapy or other cancer treatments
- for non-cancerous (benign) reasons such as urinary tract stones, an enlarged prostate, birth defects, nerve problems and tumours
Types of urinary diversions
There are different types of urinary diversions. The type of urinary diversion you have depends on many factors, including:
- your age
- how well you can move around
- how well the intestine, liver and kidneys are working
- other medical problems you have
- if you have had radiation therapy
- how close the cancer was to the urethra
- how long you are expected to live (life expectancy)
A urinary diversion can be permanent or temporary depending on why it is done. A permanent urinary diversion can be either incontinent or continent.
Incontinent urinary diversions
With an incontinent urinary diversion, you don’t control urination. A urostomy is used to continuously drain urine from the body through a stoma. The urine is collected in a small bag worn outside of the body (called a urostomy bag, appliance or pouching system). This type of diversion is used more often for people who are older or in poor health.
An ileal conduit (also called a loop diversion) is the most common type of urinary diversion done. The surgeon removes a piece of the small intestine (ileum) and uses it as a passageway (conduit) for urine. Sometimes a piece of the colon is used instead (called a colon conduit), but this isn’t as common. The ureters are placed into the piece of intestine and then each ureter is surgically attached to it. An open end of the intestine is attached to an opening (called a stoma) made in the wall of the abdomen and skin. Urine travels from the kidneys, through the ureters, into the piece of intestine and then out through the stoma. Every 3 to 4 hours, you empty the bag that collects the urine.
A cutaneous ureterostomy is when the surgeon attaches one or both of the ureters directly to the wall of the abdomen. The urine drains out of 1 or 2 stomas. This surgery is not done very often because of the increased risk of serious problems, such as kidney failure.
Continent urinary diversions
With a continent urinary diversion, you control urination. The surgeon makes a pouch to hold the urine. You drain the urine from this new pouch either with a tube (catheter) or through the urethra (as you would normally).
A continent cutaneous reservoir (Indiana pouch) is also called a continent diversion with catheterizable cutaneous stoma. The surgeon creates a pouch using the right side of the colon (cecum and ascending colon) and a piece of the small intestine (end of the ileum). There are different types of pouches, but the Indiana pouch is the most common. The pouch is attached to an opening (stoma) made in the wall of the abdomen and skin. You drain urine from the pouch by inserting a tube into the opening every 4 to 6 hours.
An orthotopic neobladder is when the surgeon makes a pouch (called a neobladder, or new bladder) usually from part of the small intestine. (Part of the colon may be used in some cases.) The ureters are attached to the pouch, which is then attached to the urethra. You empty the pouch by urinating normally. An orthotopic neobladder is a more difficult type of surgery than other urinary diversions and there is more chance of problems (complications). So it is usually done in younger people without serious medical problems.
Ureterosigmoidostomy is surgery where the ureters are connected to the sigmoid colon (the last part of the large intestine). The urine leaves the body with the stool (poop) through the anus. This surgery is not done very often because of the increased risk of many problems, including kidney infections and colon cancer.
Temporary urinary diversions
Sometimes a urinary diversion is temporary. It can be kept in place for a few days or several weeks.
A urinary catheterization is a common type of temporary urinary diversion. A thin, flexible tube called a catheter is put into the bladder to drain urine into a bag outside the body. The tube is inserted into the bladder through the urethra or a small cut (incision) just under the belly button. A urinary catheterization is often used after surgery in the lower abdomen to allow the area to heal.
A nephrostomy uses a small tube inserted directly into a kidney through the skin. The urine travels through the tube into a bag outside the body. A nephrostomy may be used while a kidney stone is removed. It may also be done when the ureters are inflamed or blocked and urine isn’t flowing properly.
How a urinary diversion is done
Your surgeon will usually mark the abdomen where the stoma will be to make sure it is in a convenient and comfortable place. Your surgeon or healthcare team may also discuss the type of pouch that you will need to use after the surgery. You may be given antibiotics before surgery to help prevent infection.
A urinary diversion is done in a hospital using a general anesthetic (you will be unconscious). Usually, a cut is made in the abdomen to reach the urinary tract and intestine (called open surgery).
During surgery, it is common to do a radical cystectomy first to remove the whole bladder. But it depends on the reason for doing the urinary diversion. A urinary diversion may be done without removing the bladder.
The surgeon uses part of your intestine to make a urostomy or internal pouch. The ureters are joined to the reconstructed intestine (conduit or reservoir) by a procedure called anastomosis. One end of intestine may be brought to an opening on the surface of the abdomen and the surgeon stitches the edges to the skin of the abdomen to make the stoma. The surgeon closes the large cut in your abdomen with stitches or staples.
After surgery, you will need to stay in the hospital for several days. You will be given pain medicines to keep you comfortable. Fluids and solid foods will be introduced slowly.
Problems after surgery
Problems (complications) can happen after urinary diversion surgery. They can happen early on after surgery (immediately after or within a few days or weeks). Sometimes late problems develop months or years after surgery. Some problems are only temporary and can be treated, but some may last a long time or become permanent.
Any problems you have depend mainly on the type of urinary diversion done and your overall health.
A urinary diversion may cause these problems:
- infection, which may cause fever or cloudy or strong-smelling urine
- a paralyzed or less active intestine (paralytic ileus)
- a blocked intestine (bowel obstruction)
- urine leaking into the abdomen
- scarring around the ureters
- narrowing of the ureters (stricture)
- stool leaking from the intestine into the abdomen
- collection of fluid in certain areas such as developing a seroma or hematoma
- urinary tract stones (urolithiasis or urinary calculi)
- back-up (reflux) of urine into the kidneys
- kidney failure
- inflammation of the internal pouch or reservoir (pouchitis)
- problems with the stoma such as bulging around the stoma (parastomal hernia) or a narrowing of the stoma (stomal stenosis)
- break of the neobladder (called a rupture)
Living with a urinary diversion
While you are in the hospital a WOC (wound, ostomy and continence) nurse will teach you how to live with the urinary diversion and care for a urostomy. Find out more about living with an ostomy.
Your healthcare team or WOC nurse could talk with you about:
- eating, drinking and nutrition
- physical activity
- showering and bathing
- how to clean and care for a stoma
- how to empty an internal pouch (continent cutaneous reservoir)
- what to do if you have problems
- when to visit the surgeon for follow-up
- support groups in your area
Special considerations for children
Preparing children before a test or procedure can help lower their anxiety, increase their cooperation and develop their coping skills. This includes explaining to children what will happen during the test, such as what they will see, feel and hear.
Preparing a child for a urinary diversion depends on the age and experience of the child. Find out more about helping your child cope with tests and treatments.
A surgical procedure to create a stoma (artificial opening) so that urine can pass out of the body through the abdominal wall.
A urostomy may be done if the bladder or urethra (the tube that carries urine from the bladder to the outside of the body) need to be bypassed or removed. A special bag (urostomy bag) is attached to the stoma to collect urine.
The last part of the small intestine that receives almost completely digested food from the jejunum, absorbs more nutrients and fat, then passes digested food to the large intestine.
The longest part of the large intestine that receives almost completely digested food from the cecum (the first part of the large intestine), absorbs water and nutrients and passes waste (stool or feces) to the rectum.
The colon is made up of 4 parts. The ascending colon starts at the cecum and goes up the right side of the abdomen. The transverse colon goes across the upper abdomen. The descending colon goes down the left side of the abdomen. The sigmoid colon is the last part of the colon that connects the descending colon to the rectum.
Sometimes called the lower intestine or large bowel.
An artificial opening in the body created by surgery.
Stomas may be created to connect an organ or structure to the surface of the body.
A flexible tube used to carry fluids into or out of the body.
For example, an intravenous catheter delivers fluid into the body through a vein and a urinary catheter carries urine from the bladder out of the body.
A drug that causes anesthesia (the loss of some or all feeling or awareness).
General anesthetics put a person to sleep. Regional anesthetics cause a loss of feeling in a part of the body, such as an arm or leg, but the person does not lose awareness. Local anesthetics numb only a small area of the body.
A non-cancerous (benign) mass or swelling caused by the buildup of serum (the clear portion of any body fluid) in a tissue or organ.