The Urinary Diversion Questions Women Are Afraid to Ask

July 20, 2026

Transcript

Voice over:

This is Bladder Cancer Matters, the podcast for bladder cancer patients, caregivers, advocates, and medical and research professionals. It’s brought to you by the Bladder Cancer Advocacy Network, otherwise known as BCAN. BCAN works to increase public awareness about bladder cancer, advances bladder cancer research, and provides educational and support services for bladder cancer patients and their loved ones. To learn more, please visit bcan.org.

Rick Bangs:

Hi, I’m Rick Bangs, the host of Bladder Cancer Matters, a podcast for, by and about the bladder cancer community. I’m also a survivor of muscle invasive bladder cancer, the proud owner of a 2006 model year neobladder and a patient advocate supporting cancer research at the Bladder Cancer Advocacy Network, or as many call it, BCAN, producers of this podcast. I’m pleased to welcome today’s guest, Dr. Christine Ibilibor. Dr. Ibilibor is an assistant professor in the Department of Urology, Division of Urologic Oncology at the University of Virginia, and she specializes in using robot-assisted surgical approaches for the treatment of urologic malignancies. Her research interests include patient longevity and wellness with the utilization of mindfulness and aerobic exercise as vehicles for prehabilitation in the perioperative period for patients undergoing radical cystectomy. As a member of the Women and Urologic Oncology Executive Committee at the Society of Urologic Oncologists, Dr. Ibilibor is committed to promoting the recruitment and retention of women in urologic oncology at all levels of training and helping ensure the equitable care of women and men with urologic malignancies. Dr. Ibilibor, thanks for joining our podcast.

Dr. Christine Ibilibor:

Thank you so much for having me. I’m really excited to be here.

Rick Bangs:

And we’re excited. This is a great topic. So we’re going to talk about women and choosing a diversion. So can you talk about what’s some of the criteria, the major criteria that patients, male and female, would consider when choosing a diversion?

Dr. Christine Ibilibor:

Yeah. So patients always ask me which diversion is best, and they want to have the best diversion, but really choosing one is an individualized based decision. It’s made between them and their surgeon because it depends on quite a few factors, the person’s kidney function, the type of tumor that they have and its location, as well as the characteristics of their small intestines because these are used to construct their diversion. And then, in addition to that, it’s the person’s choice in which way they feel that they could manage their urine after surgery. And that really varies very widely between the different types of diversions. Broadly, it kind of comes down to whether someone feels like they could manage their urine through their urethra, their native urethra, or through a surgically formed stoma on their abdomen. And then again, whether their tumor location, kidney function and small bowel or small intestines can accommodate the type of diversion. So it’s a very complicated decision. And I’m curious, Rick, how did you make yours?

Rick Bangs:

Well, back in 2006 it was not, as you might expect, not a lot of information. So I couldn’t listen to a podcast. I could not go to a webinar. Honestly, I couldn’t even talk to another survivor. So I had to use, what limited information I used was out on the internet, and it was, I think one or two major cancer centers sites had some very medical information. So I kind of had to make a decision, and of course I talked to my surgeon, but I kind of had to make a decision without really understanding what was daily living going to be like with that, let alone my recovery and all those things. So if I’m looking to find a surgeon to do a diversion, particularly a specific diversion that I might want, how would I find one?

Dr. Christine Ibilibor:

The best way to do that is any cancer center that either has surgeons working there or medical oncologists, genitourinary medical oncologists who treat bladder cancer, who can refer you to a surgeon as well. So your local cancer center is certainly the first place you want to go to.

Rick Bangs:

Okay. All right. And then, I want to talk about males versus females. So tell me what you see as some of the criteria that are more likely to be considered by males when they’re making a diversion choice.

Dr. Christine Ibilibor:

Men are certainly not different from women, but probably more conversations that I have with men surround their erectile function after surgery. It’s a big surgery. A lot of organs are removed and moved around, and their erectile function is vastly affected by that. So oftentimes that’s one of the first things, especially younger men, will ask me what their sexual function will be after surgery as compared to women at least.

Rick Bangs:

Okay. And then what about females? What do they tend to focus on?

Dr. Christine Ibilibor:

Socially, we are certainly taught to be more concerned about our appearance, and body image is a big one after these procedures and whether a diversion will be something that will affect the way they look at themselves and the way other people look at them, especially their partner. So kind of their views about their own body after the surgery, and then probably views of a significant other are also big concerns that I talk with my women patients about.

Rick Bangs:

Okay. So I want to focus, go a little deeper on the differences. And I frankly don’t know the answer to these questions, which is why I’m going to ask them. So surgical time, operating time, is it the same for males versus females? Because you’re dealing with different anatomy. Is the scar length going to be the same? Is my recovery longer or shorter? If I choose a neobladder with the training period as they call it, would that be a different length? What are some of these kind of differences?

Dr. Christine Ibilibor:

That’s a really good question. And they vary very widely depending upon the diversion. Ileal conduits are probably the shortest surgical time because it requires constructing tube or the ileal conduit segments from the bowel and then just attaching the ureters, the kidney tubes essentially. Whereas, constructing a neobladder that requires taking a tubularized intestines, detubularizing it, folding into a spherical shape or reservoir and then attaching the ureters. And then an Indiana pouch, which is also a type of diversion, requires a similar amount of reconstruction using the bowel, patching the ureters, and then also constructing the actual catheterizable channel that’s attached for collecting the urine. So for a conduit, it can take about an hour, maybe an hour and a half. Whereas a neobladder or Indiana pouch can take approximately three to four hours to construct. So the length of time of the entire procedure can vary widely between the different diversions.

But between women and men in that regard, they’re probably about the same because the organs that are removed are about the same in size. Maybe if a woman still has her uterus that is sometimes removed, but sometimes it is preserved as well. And then recovery time is probably about the same. Recovery meaning, at least what I describe to my patients, getting back to yourself, that’s about the same for most people. Takes about two to three months at times where you’re back to your same energy level. And then the neobladder training, that can take a bit of time, but it probably takes the same amount of time required to get adjusted to an externalized appliance as well for a conduit or learning how to catheterize yourself for an Indiana pouch.

Rick Bangs:

All right. So now, I always am interested when I talk to urologic oncologists, because remember what I said I didn’t know, and this is really important stuff. So how do you describe living with each of the three diversions? Because I believe you do all three diversions, right?

Dr. Christine Ibilibor:

I do not do Indiana pouches.

Rick Bangs:

Okay.

Dr. Christine Ibilibor:

I do neobladders as well as conduits. Indiana pouches are pretty tough to make, and it is kind of hard to find a surgeon that does those. I do have a colleague who does though.

Rick Bangs:

Okay. All right. So again, ask your major cancer center, particularly for this one. Okay. So now how do you describe the two that you do? How do you describe living with a neobladder or living with an ileal conduit? What do you say to your patients?

Dr. Christine Ibilibor:

I first tell people that regardless of which one you choose, it’s a big adjustment, major adjustment that is generally permanent, except in really extenuating circumstances. And that despite the big change, everyone adjusts to the new way of managing their urine. And then lastly, no one ever knows what type of diversion that you have chosen unless you tell them or show them. So for a conduit, and that’s with the external appliance, an external stoma, I tell people again, no one can see that under your clothes unless you show them. No one can smell your urine at all. It’s a watertight appliance. And I tell people that it is challenging adjusting to kind of applying the appliance, learning all the different tools you need to use to change out the appliance, and then having your own bag of supplies that you have to take out, take around with you.

All the type of diversion do require some amount of supplies to go with you, whether you travel or you’re out and about. And that just takes time to know what works for you. And I tell everyone it’s going to be trial and error, and we’ll learn together which one is best for you, what’s best for your skin. There may be certain adhesives that are rough on your skin, other materials that might be difficult [inaudible 00:10:32] and there’s others that are best for it. So it’s really individualized, and it’s a bit of a learning curve. And then for neobladders training, it does require some amount of catheterization and learning what size catheter works best for you. And then learning when your neobladder is full and when it feels empty, that sensation is really different. Requires a lot of adjustment to different sensations that might be new. I do rarely have some patients with a neobladder who feel like their native bladder is still there, which is very uncommon. But again, I tell people it’s really them learning, and we’re all kind of learning together.

Rick Bangs:

Yeah. That makes sense. So what are some of the most common questions you’re going to get from your female patients, and are they different from the questions you get from men?

Dr. Christine Ibilibor:

The first thing I oftentimes have women ask me is what type of clothing they can wear to either conceal a urostomy bag, things like that. Men don’t often ask me how to conceal their bag. I actually had a male patient once tell me a story of when he was in the grocery store, and a person, a man that he didn’t know at the grocery store saw my patient’s Foley bag because he was carrying it with him. And he hadn’t had his bladder removed yet, but he was scheduled for it. And the person at the grocery store looked at his Foley bag and was like, “Oh yeah, I’ve been there.” And he pulled up his shirt and showed my patient his ileal conduit stoma bag in the middle of the grocery store. And while that story is pretty extreme, because even my patient was kind of shocked that a stranger showed him his conduit-

Rick Bangs:

In the middle of the produce aisle.

Dr. Christine Ibilibor:

Women are probably less likely to reveal their external appliance.

Rick Bangs:

Probably so. Probably so.

Dr. Christine Ibilibor:

[inaudible 00:12:37] interested in how to conceal it and to make sure no one knows about it.

Rick Bangs:

Right, right. But for the men, I would think some men are swimmers. And so I do see some things online, and I’m just curious, do you have men asking you about swimming with an ileal conduit?

Dr. Christine Ibilibor:

I do. And I tell them that because it’s waterproof, it should be fine to not slip off. But I do also tell them leaks are possible as your skin’s kind of getting used to the adhesive. Sometimes it can slip off in the water in an inopportune place. So having your supplies is really important. And then I also just try to normalize it. These social situations that are really not desirable. They don’t define you. You’ve been through a lot, and if your bag slips off in a place that you didn’t want it to, I wouldn’t diminish the achievement that you’ve made already going through bladder cancer surgery and care and things like that.

Rick Bangs:

Okay. So we did a podcast with Dr. Armine Smith and she revealed something that I had not realized, which is that the walls of the female bladder are thinner than the male. So why would that be? And I know it has implications on the TURBT. Does it have implications on the radical cystectomy as well?

Dr. Christine Ibilibor:

Yeah, that’s a great question. So women do have slightly thinner bladder wall than men because men have a prostate as well as a longer urethra compared to women that provide more resistance to flow. So a man’s bladder requires more muscle to expel urine from the bladder, which makes it thicker than a woman’s. But it doesn’t necessarily have implications for removing the bladder during radical cystectomy. It doesn’t make it more or less difficult.

Rick Bangs:

All right. So now we’re going to play fact or fiction here because I hear this from time to time historically anyway, maybe not necessarily now, but neobladders are more challenging to own as a female. Is that fact or is that fiction based on your experience with your patients?

Dr. Christine Ibilibor:

Definitely fiction. Neobladders are connected to the urethra, and they require some level of catheterization at least once daily to irrigate. And women, we have a shorter urethra that is a lot less prone to stricture disease compared to men. So catheterization can actually be slightly easier for women, and then long-term not having issues with obstructive urinary symptoms as well. And from a technical standpoint, though the construction is not more or less challenging in a woman or a man while building the neobladder, really again, the challenges arise from whether the length of the blood supply to the small intestines or whether there’s cancer at the urethra.

Rick Bangs:

All right. Any final thoughts?

Dr. Christine Ibilibor:

I would just like to reiterate that the choice of a urinary diversion is a very personalized, individualized choice, and that women, we have unique considerations compared to men that should always be taken into account.

Rick Bangs:

All right. Good advice. Okay. So Dr. Ibilibor, I want to thank you for explaining some of the considerations for choosing a urinary diversion as a female bladder cancer survivor. If you would like more information on bladder cancer, please visit the BCAN website, www.bcan.org. Now, in case people wanted to get in touch with you, could you share some contact information that people would be able to use?

Dr. Christine Ibilibor:

Absolutely. They can contact the Emily Kerr Cancer Center in Charlottesville, Virginia. And the number to the cancer center is 434-924-9333.

Rick Bangs:

Just a reminder, if you’d like more information about bladder cancer, you can contact the Bladder Cancer Advocacy Network at 1-888-901-2226. That’s all the time we have today. Please like, comment, and subscribe so we have your feedback. Thank you for listening, and we’ll be back soon with another interesting episode of Bladder Cancer Matters. Thanks again, Dr. Ibilibor.

Voice over:

Thank you for listening to Bladder Cancer Matters, a podcast by the Bladder Cancer Advocacy Network or BCAN. BCAN works to increase public awareness about bladder cancer, advance bladder cancer research, and provide educational and support services for bladder cancer patients. For more information about this podcast and additional information about bladder cancer, please visit bcan.org.