What is a Urinary Diversion Procedure?

Urinary diversion is a procedure to redirect the flow of urine when there is a blockage or a diseased part of the body. The urinary tract is the system in which urine flows from your kidneys to the bladder and out of your body. It removes both water and waste products. When there is a blockage, not enough urine can leave the body.

The Urinary diversion procedure is a surgery that creates an alternative route for bodily fluids to flow away from the bladder and exit your body. Urinary diversion can be temporary or permanent.

Why Might I Need a Urinary Diversion Procedure?

You might need a urinary diversion for many reasons. Cystectomy, a bladder cancer surgery that removes the bladder, is the most common reason.

Additional reasons you might need a urinary diversion procedure:

• Urinary stones — When the minerals in urine form crystals, they can sometimes develop into a hard mass. This often happens when you need to use the bathroom, but you are unable to completely empty your bladder.
• Genitourinary tract tumors — The genitourinary tract is the system of organs involved in creating and excreting urine, as well as reproduction. The genitourinary tract consists of the kidneys, bladder, fallopian tubes, and reproductive organs. Tumors in the genitourinary tract can cause problems for urination or sexual function.
• Trauma — Injury to the urethra, pelvis, and bladder can disrupt urine flow.
• Nerve damage — Birth defects like spina bifida, spinal cord injury, or multiple sclerosis can cause nerve damage to your bladder.
• Outside pressure — Some health conditions cause excess pressure on the urinary system, preventing urine from flowing freely.
• Bladder inflammation — Regular infections, interstitial cystitis, or severe urinary retention can cause long-term inflammation of the bladder.
• Radiation therapy — This therapy can permanently damage the bladder.
• Chronic urinary retention — Chronic urinary retention, or the inability to fully empty your bladder enough times a day and night is generally due to enlarged prostate glands or benign prostatic hyperplasia. This can be managed with medications but might require a less invasive surgical procedure, such as urinary diversion surgery.
• Urinary incontinence — Some urinary incontinence is severe and does not respond to standard treatment options.

Urinary Diversion Types

There are several different urinary diversion types: bladder catheterization, cystostomy, nephrostomy, ureteral stent, urostomy, and continent urinary diversion. These urinary diversion options redirect urine flow out of your body.

Bladder catheterization

Bladder catheterization involves inserting an indwelling tube through which urine flows into an external bag or appliance for drainage from the body. This type of urinary diversion might be necessary if there is an obstruction in the urinary tract due to kidney stones or cancerous tumors.

Bladder catheterization can be temporary or permanent. There are two main types of catheters. A catheter inserted through your urethra is known as a foley catheter. A catheter inserted through an incision underneath your belly button is called a suprapubic catheter.

Cystostomy

A cystostomy is a surgical procedure that creates an opening in the bladder through the abdominal wall to allow urine to drain into a collection bag (or container).

Nephrostomy

Nephrostomy is a surgical procedure that diverts urine from your kidney to an external collection bag. Your doctor makes an incision in your back to reach your kidney.

Nephrostomy can be used when you experience kidney stones or there is a problem with your ureters. This type of urinary diversion can be temporary or long-term.

Ureteral stent

A ureteral stent is a thin tube that is inserted into the ureter to hold it open. This procedure allows urine to freely flow between your kidney and bladder.

A urinary diversion stent goes into the ureter with a camera and then one end of the tube is positioned in your kidney. The other end of the stent is positioned in your bladder.

Urostomy

A urostomy is a surgically created opening in the skin of the abdomen near your bladder. This opening is also called a stoma. The urostomy will allow urine and other bodily fluids to flow from the body into an external collection bag.

There are two main variations of this procedure: Cutaneous ureterostomy and ileal conduit. In cutaneous ureterostomy, a surgeon connects one or both ureters to an abdominal opening. In ileal conduit urinary diversion, a portion of the ileum — the end part of the small intestine — is surgically connected to the ureters and the opening in your abdomen.

Continent urinary diversion

Continent urinary diversion is when you can control your urination by storing urine in an internal storage compartment in your bowel or bladder. There are two main types of continent urinary diversion surgery.

The two types include:

• Bladder substitute — A surgeon can take a piece of your bowel and make it into a bladder substitute. The new bladder will hold urine that is then released through your urethra.
• Continent cutaneous reservoir — A surgeon creates an internal pocket from a segment of your bowel. The organic pocket is then placed inside your stomach. Urine is stored in the pocket until you place a catheter tube into your bladder. This is called continent urinary diversion.

Complications

When you undergo a urinary diversion procedure, you may experience complications. The specific complications depend on the underlying issues of your condition.

Complications of a urinary diversion might include:

• Fluid collection — You might experience a collection of fluids that can cause pain, swelling and redness.
• Urine leak — Urine might leak inside your stomach.
• Rupture — Your neobladder can break. A neobladder is a temporary or permanent substitute for the urinary bladder.
• Stricture — Your ureters may thin or narrow. This means urine might not flow as well through your body.
• Ureter scarring — There might be scars around your ureters.
• Paralytic ileus — An intestine with reduced activity.
• Bowel obstruction — A blocked intestine is when food cannot go through your intestines. It can be a serious health complication.
• Kidney failure — Kidney failure is when your kidneys can no longer filter waste from your blood.
• Leaking intestine — Stool may leak from your intestine into your abdomen. This can cause severe discomfort and pain.
• Pouchitis — This is when your urinary pouch becomes inflamed.
• Urinary tract stones — Urinary tract stones are hard pieces of minerals that crystalize. They can lead to other severe complications.
• Urine reflux — Urine might back-up into your kidneys.
• Stoma issues — You might develop a swollen stoma or narrowed stoma.
• Infection — Urinary tract infections can result in a fever or cloudy urine.

Living with Urinary Diversion

Your medical team will share with you how to live with urinary diversion. A urinary diversion procedure may limit certain activities.

Activities to discuss with your doctor:

• Bathing/Showering — It is important to take care of the area around your stoma when showering. Do not rub your stoma or the area directly surrounding your stoma. Allow soapy water to run over the stoma. Use a towel to gently dab the area dry.
• Physical activity — You can exercise with a stoma, but you may want to start with easier, low-impact activities.
• Caring for a stoma — Use wet wipes or a dry cloth to clean a stoma after using the restroom. Using regular toilet tissue can feel uncomfortable.
• Social support — It can be helpful to your social and emotional health to seek support from other individuals in a group setting.
• Nutrition — Your medical team will recommend a nutritional plan customized to your individual needs. Many people avoid foods and drinks that cause digestive problems.
• Relationships — Going through a urinary diversion can impact your self-image, emotional regulation, and relationships with others.
• Emptying an internal sac — Your medical team will instruct you when and how to empty your internal pouch.
• Follow-up appointments — You will likely schedule follow-up appointments with your doctor to discuss any issues after the procedure.
• Responding to problems — Ask your doctor what to do if you experience any problems with urinary diversion. Discuss common complications and when to seek medical attention.