Urologic Conditions & Treatments

Urinary Diversion Chattanooga TN

What is Urinary Diversion?

Urinary Diversion is a surgical procedure where the flow of urine is diverted from its normal pathway because the bladder has been removed, or urine flow is obstructed. It can be temporary or permanent. A permanent type of urinary diversion is where the urine flow is rerouted to an external pouch through an opening in the abdomen creating a stoma (an opening on the outside of the body) or by surgical creation of an internal reservoir. Temporary urinary diversion may be in the form of catheters placed within the bladder or kidney.

Why is it necessary?

When urine flow is blocked it accumulates in the urinary tract and can cause pain, urinary tract infections, kidney infections and even death. Temporary diversion may be needed until a blockage is removed or after urinary tract surgery. Permanent diversion is necessary when the bladder is severely damaged, has been removed due to cancer, or when there is severe nerve damage, birth defects or chronic inflammation.

Types of Urinary Diversions

  • Continent urinary diversion. Continent diversion allows a patient to urinate spontaneously without an appliance or collecting device. It is the surgical creation of an internal reservoir (under the skin) or construction of a replacement bladder. There are two types:
  • Continent cutaneous reservoir or Indiana Pouch (continent stoma) is a surgically constructed reservoir connected to a stoma (opening). The surgeon creates a valve to keep urine from flowing out of the stoma. Urine flows through the ureters and is drained by the patient, with a catheter, several times a day. The stoma is very small and can sometimes be hidden in the belly button. Continent Stomas require daily care to maintain a clean and healthy stoma. Home care is vital to your health. A specialist will train you in the proper maintenance program.
  • Neobladder- The surgeon creates an internal reservoir that connects to the ureters at one end and the urethra at the other. Urine empties into the new reservoir just as the natural bladder did. Clean intermittent catheterization may be required to completely empty the reservoir. Women are more likely than men to do this at home. To be eligible for this surgery, the patient must be motivated to take care of the diversion, have intraoperative findings that are appropriate for neobladder creation and be able and willing to use a catheter, if necessary.
  • Non-Continent Diversion. It involves connecting the ureters to an opening on the outside of the body to allow urine to drain into an external pouch. The patient wears an ostomy bag and urine continuously drains into it. There are 2 types:
  • Ileal Conduit- a section of the bowel is surgically removed and repositioned as the passage from the ureters to the stoma. This is the oldest and simplest form of urinary diversion.
  • Colon Conduit- here a section of the colon is used when use of the ileum is not appropriate.

A non-continent stoma requires daily care to maintain healthy skin in the area around the attached pouch.

Risk of Infection

No matter the surgical method chosen, there is a high risk of infection because bacteria often enter urostomies and continent urinary diversions. Signs of infection include:

  • Fever
  • Milky urine or mucus in the urine
  • Strong urine odor
  • Back pain
  • Poor appetite
  • Nausea
  • Vomiting

If you have any of these symptoms, contact your doctor immediately. Drinking lots of water can prevent infection by flushing out bacteria. Urine testing and infection treatment are critical.

Other issues

Activities may need to be restricted for the first few weeks after surgery. Once the stoma is healed many patients can enjoy normal activities except for contact sports. This type of surgery can reduce sexual function. Talk to your physician about your concerns. You will likely be able to resume normal diet. With continent urinary reservoirs you may need regular vitamin B injections.

Other concerns

Alterations in fluid or salt balance, metabolic changes, difficulties inserting the tube in the stoma, skin growth over the surgical opening; bowel obstruction, urine leakage and bowel leakage are all possible and will be reviewed by your urologist at length. Generally these surgeries are well tolerated and most patients can be rehabilitated to normal activity and a normal lifestyle.

Urinary diversion surgery requires highly qualified surgeons who perform this procedure regularly like the experts at UT Urology. Our surgeons are sensitive to your needs and will balance your health needs with quality of life and independence considerations. We offer the latest cutting-edge techniques to meet your individual needs.

 

 

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