Urinary diversion - Urostomy - continent and incontinent
What is Urinary diversion and Definition
A surgical procedure to create a method for the storage and passage of URINE from the body after cystectomy (surgical removal of the BLADDER). Though most often necessary following cystectomy to treat BLADDER CANCER or invasive cancer of the pelvic region, urinary diversion may be necessary after traumatic injury to the bladder. Urinary diversion may also be a palliative treatment for inoperable bladder or pelvic cancer, diverting the flow of urine to overcome urinary obstruction. Urinary diversion may be continent (collects and contains urine within the body), which most people prefer when it is possible, or incontinent (collects a steady flow of urine in a bag outside the body).
Continent Urinary Diversion
When the urethra remains intact the urologic surgeon can fashion a substitute bladder, called a neobladder, from a segment of bowel (which has the ability to expand somewhat), attaching the ureters and the URETHRA. The neobladder allows the person to urinate naturally. However, the neobladder requires more frequent, and usually timed or scheduled, emptying as it lacks the distention ability and capacity of the native bladder as well as the nerves that activate the micturition REFLEX.
When the cystectomy also includes removal of the urethra, the surgeon generally chooses to craft a collection reservoir from a segment of SMALL INTESTINE that remains in the abdominal cavity, then create a valved opening through the abdominal wall into the reservoir. The person periodically inserts a catheter into the opening to drain the urine, usually every three to four hours, including through the night. Though not as natural as the neobladder, the catheter reservoir still permits urinary continence.
Incontinent Urinary Diversion
Incontinent urinary diversion is similar to the catheter reservoir, except the opening through the abdominal wall, called a stoma, lacks a valve. The person attaches an ostomy bag over the opening using special adhesive. Urine drains continuously into the bag, and periodically the person removes the full bag and replaces it with a clean, empty bag. The bags are small and unobtrusive beneath the clothing. The adhesive ensures there is no leakage of urine. A urostomy bag may require changing every six to eight hours. Surgeons use this method, called urostomy or ileal conduit, primarily when continent urinary diversion is not a viable option.
Outlook and Lifestyle Modifications
Urinary diversion requires diligent attention to hygiene and emptying collected urine. Though the neobladder is the most natural urinary diversion method, it requires more frequent emptying than would the natural bladder. Likewise the catheter reservoir, which further requires the person to carry a catheter at all times. URINARY TRACT INFECTION (UTI) tend to be more frequent in people who have any form of urinary diversion, though are most common with urostomy. Urostomy also may cause irritation to the SKIN around the stoma. Many people who have urostomies or catheter reservoirs feel self-conscious about them. The urologist or hospital can provide information about support groups where people who have urinary diversions can share their concerns and experiences.
See also COLOSTOMY; ILEOANAL RESERVOIR; ILEOSTOMY; QUALITY OF LIFE; SURGERY BENEFIT AND RISK ASSESSMENT.
