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Urinary Diversion: What Is It? What Are My Options?

If you or someone you know has been diagnosed with bladder cancer, your doctor may recommend a radical cystectomy (complete removal of the bladder) to prevent further cancer spread. Radical cystectomy is a life-changing procedure, and choosing a urinary diversion is not an easy decision. We’re here to break down the information for you, and help you understand you can live a normal life without a bladder.

Download our “What is a Radical Cystectomy” Fact Sheet

What Is a Urinary Diversion?

A urinary diversion is a surgical procedure that reroutes the normal flow of urine out of the body. It can be helpful to understand the functions of the bladder to understand the purpose of a urinary diversion: One function is the storage of urine. The bladder has a fairly large capacity to store the urine. The other function it serves is to expel the urine, to get it out of the body. So if a patient undergoes a cystectomy and has their bladder removed, the patient needs a new way of getting their urine out of the body and having another storage capacity. Some of the urinary diversion options below have both of these functions, whereas some have one.

Urinary Diversion Options

There are different options available for urinary diversion. They include ileal conduit, neobladder, and Indiana pouch (also known as a continent urinary diversion). The right option for one person might not necessarily be the right option for another patient. Some of the factors that must be considered when deciding which option include your overall health, the total amount of time required in the operating room, whether the urine collects outside of your body, and whether occasional catheterization has to be used.

Ileal Conduit

Illustration of an ileal conduit

One of the most common options is an ileal conduit. In this treatment procedure, a segment of the intestine will direct your end through a stoma, or hole on the outside of your body, and into a collecting bag. A segment of the ileum, which is a part of the small intestine, will be used to carry urine from the kidneys through an opening in the abdominal wall. Then, there will be a bag that collects the urine. You will have to change the bag when it gets full, but this option does not take as long to complete.

Download our “What is an Ileal Conduit” Fact Sheet

Neobladder

Illustration of a neobladder

Another option is called neobladder. In this procedure, a small portion of the small intestine is turned into a pouch or reservoir. It will be connected to the  the ureters which will drain urine from the kidneys where it is formed, into the pouch.  The neobladder is connected to your urethra to allow you to empty your bladder. Because the bladder is a muscle that contracted to expel urine, you will have to learn to  will use your abdominal muscles to control the flow of urine out of your neobladder.

The biggest advantage of this procedure is that the process of urination will be similar to normal urination. You don’t have to worry about having a stoma, but the surgery time is a bit longer. You may need to learn how to use the neobladder, so there might be some incontinence during the early stages. A disadvantage of the neobladder is that it does not have the capacity to hold as much urine, which means you may have to wake up to empty the neobladder during the night.

Download our “What is a Neobladder” Fact Sheet

Indiana Pouch (Continent urinary diversion)

Illustration of an ileal conduit
Illustration of an ileal conduit

The final option is called the Indiana pouch. In this procedure, a pouch will be made using portions of your intestines. This pouch is connected to a stoma which creates an opening in the abdominal wall, usually near your belly button. This pouch will be used to store urine until it is drained using a thin tube called a catheter. Generally, a portion of the large intestine is taken from the ascending colon on the right side of your abdomen. Then, it is combined with a portion of the ileum. The ureters drain the urine into this pouch. A one-way valve is installed to keep the urine inside the pouch.  Then, a few times per day, you will pass a catheter through a stoma to empty the urine bag.

One of the major advantages of this option is that you do not need to worry about having an external bag on the outside of your body. You don’t have to worry about odors, and you can cover the stoma with a bandage. This surgical procedure does take a bit longer, and you do need to pass a tube into your body to empty the urine.

You may find it helpful to watch our Treatment Talk about Indiana pouches or you can download our “What is an Ileal Conduit?” fact sheet.

Follow-Up Care After Urinary Diversion

After the procedure, you must make sure you keep your follow-up appointments with your healthcare team to  ensure the site does not get infected. Urinary tests will be conducted to ensure the urinary diversion is working properly. Blood tests and x-rays might also be done to ensure the procedure is healing appropriately. If you have issues with controlling urination, make sure to share these issues in your follow-up appointments.

FAQs about Urinary Diversion

Some of the most common questions people ask include:

What is the most common reason why someone requires a urinary diversion?

The bladder cancer patients who are encouraged to have a cystectomy and urinary diversion are those whose cancer is relatively confined to the bladder and where removing the bladder gives the doctor a chance of curing the patient.

Another set of patients who may benefit from bladder removal and urinary diversion are those whose bladder cancer is advanced, but their quality of life can be improved significantly by removing the bladder, and therefore mitigating or getting rid of the side effects or complication that they’re having as a result of having their bladder in place. For example, excessive bleeding from the bladder tumor, excessive urinary difficulty or pain as a result of the bladder.

Which option is best for urinary diversion?

The satisfaction levels are similar for each urinary diversion option , and ultimately it comes down to the trade-offs and differences between each option.

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