Urinary Diversion: Types and Options After Bladder Removal 

A urinary diversion is a surgical procedure that creates a new way for urine to leave the body when the bladder has been removed or can no longer function normally. After bladder removal surgery, or radical cystectomy, the main urinary diversion options are an ileal conduit, neobladder, and continent cutaneous reservoir, sometimes called an Indiana pouch.  

Why is a urinary diversion needed after bladder removal?

Your kidneys continuously make urine, which normally travels through two tubes called the ureters to the bladder. The bladder stores urine until you urinate.  

If the bladder is removed during a radical cystectomy, your surgeon must create a new way to collect or remove urine from your body. This is called a urinary diversion.  

For some people with bladder cancer, a radical cystectomy and urinary diversion are recommended as part of treatment.  

Learn more about bladder removal surgery and radical cystectomy, or download BCAN’s radical cystectomy fact sheet.

What are the types of urinary diversion? 

The three main urinary diversion options after bladder removal are:  

1. Ileal conduit: Urine flows through a small piece of intestine to a stoma in the abdomen and collects in an external urostomy pouch.  

2. Neobladder: A reservoir made from intestine is connected to the urethra so urine can leave the body through the urethra.  

3. Continent cutaneous reservoir: An internal pouch made from intestine stores urine. The pouch is emptied by inserting a catheter through a small opening, or stoma, in the abdomen.  This type of diversion is sometimes called an Indiana pouch.

What is an ileal conduit?

An ileal conduit uses a short piece of the small intestine, called the ileum, to create a pathway for urine. The ureters are connected to the conduit, and urine flows through a stoma in the abdomen into an external urostomy pouch.  

An ileal conduit is the most common type of urinary diversion after radical cystectomy.  

Learn more about living with an ileal conduit.  

What is a neobladder?

A neobladder is an internal reservoir created from a section of intestine. It is connected to the urethra, allowing urine to leave the body through the urethra rather than through an abdominal stoma.  

People with a neobladder must learn a new way to empty it because the intestinal tissue does not contract like the original bladder. Some people may also need intermittent catheterization.  

Download BCAN’s “What Is a Neobladder?” fact sheet (PDF).

What is a continent cutaneous reservoir? 

A continent cutaneous reservoir or Indiana pouch, is an internal pouch made from intestine that stores urine inside the body. The pouch connects to a small stoma in the abdomen. Instead of wearing an external collection bag, the person inserts a catheter through the stoma several times each day to drain urine.  

An Indiana pouch is one type of continent cutaneous reservoir.  

Watch BCAN’s Treatment Talk about living with an Indiana pouch.

There is no single urinary diversion option that is best for every person. Your surgeon will consider your cancer, overall health and anatomy, while your preferences and lifestyle can also play an important role.  

How do I choose a urinary diversion?

Factors may include:  

• The location and extent of your bladder cancer  

• Kidney, bowel, heart and lung health  

• Whether you are medically eligible for a particular diversion  

• Whether you are comfortable wearing an external urostomy pouch  

• Whether you are able and willing to use a catheter  

• Your daily activities and lifestyle  

• Your ability to manage the diversion over time  

Ask your surgeon which urinary diversion options are medically appropriate for you before comparing the advantages and challenges of each.  Use Use Memorial Sloan Kettering Cancer Center’s urinary diversion decision tool.

What is recovery and follow-up like after urinary diversion?  

After bladder removal and urinary diversion surgery, your healthcare team will teach you how to care for your new urinary system. The specific care you need depends on the type of diversion you have.  

Follow-up care may include monitoring kidney function, checking how well urine is draining, blood and urine tests, imaging when needed, and help managing the stoma, pouch, neobladder or catheterization.  

Contact your healthcare team if you develop new or worsening symptoms or have difficulty managing your urinary diversion. 

Hear directly from survivors with different diversion types.

Frequently asked questions about urinary diversion

What is a urinary diversion?  

A urinary diversion is surgery that creates a new way for urine to leave the body when the bladder has been removed or no longer works normally. Urinary diversion is commonly created during radical cystectomy for bladder cancer.  

What is the most common urinary diversion after bladder removal?  

The ileal conduit is the most common urinary diversion after a radical cystectomy. A short section of small intestine creates a pathway that allows urine to flow through a stoma into an external urostomy pouch. 

Which urinary diversion is best? 

There is no single best urinary diversion for everyone. The right option depends on factors such as the location of the cancer, overall health, kidney and bowel function, anatomy, lifestyle and personal preferences. Some people may not be medically eligible for every type of diversion. 

Can you live a normal life after urinary diversion?  

People with all three types of urinary diversions can return to many of their usual activities after recovery. Daily routines differ depending on the diversion, so learning what life is like with each option can help patients make an informed decision.  

Keep Reading

• Video series: The New Normal: Living with a Urinary Diversion
• Patient story: Lionel’s Story: A Great Life with a Neobladder, 25 Years Later
• Podcast: “I Think I am Probably the Happiest Ileal Conduit Person in the World” with Vicki S.

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