Introduction
Urinary diversion is a surgery that creates a new path for urine to leave your body. This becomes necessary when your bladder must be removed or isn’t working properly. The surgery might be needed due to disease, injury, or birth defects.
Medical advances have greatly improved these procedures over the years. Today’s methods offer better quality of life and fewer problems after surgery.
This guide will help you understand the types of urinary diversions, why they’re needed, how they work, and what to expect afterward.
What Is Urinary Diversion?
Urinary diversion creates a new way for urine to exit your body when your bladder can’t do its job.
Your urinary system normally works like this: Your kidneys filter waste from your blood to make urine. The urine travels through tubes called ureters to your bladder. Your bladder stores the urine until you’re ready to pee through your urethra.
When this normal path doesn’t work, urinary diversion creates a new route. Surgeons often use parts of your intestine to create new pathways or storage pouches for urine.
When Is Urinary Diversion Needed?
You might need urinary diversion for several reasons:
- Bladder cancer: If your bladder must be removed
- Nerve problems: Spinal cord injuries, multiple sclerosis, or spina bifida can affect how your bladder works
- Birth defects: Such as bladder exstrophy, where the bladder forms outside the body
- Chronic pain: Severe bladder pain that doesn’t respond to other treatments
- Radiation damage: Long-term bladder harm from cancer treatments
- Serious injuries: Severe trauma to your lower urinary tract
- Ongoing infections: When other treatments can’t stop repeated urinary tract infections
- Severe leaking: Incontinence that doesn’t improve with other therapies
Types of Urinary Diversions
There are three main types of urinary diversions. Each works differently and has its own pros and cons.
Incontinent Urinary Diversions
These diversions drain urine constantly without any control. You’ll need to wear an external bag.
Ileal Conduit (Bricker’s Diversion)
This is the most common type, used in about 80% of urinary diversion surgeries.
How it works:
- Surgeons take a small piece of your small intestine (ileum)
- They close one end and attach your ureters to it
- The other end creates an opening (stoma) on your belly
- Urine flows from your kidneys through this new path and out the stoma
- You wear a bag over the stoma to collect urine
Benefits:
- Simpler surgery
- Fewer complications
- Shorter operation time
- Good option for older patients
Drawbacks:
- Need to wear an external bag
- Possible skin irritation around the stoma
- May affect body image
- Ongoing need for supplies
Continent Urinary Diversions
These create an internal pouch to store urine inside your body. You empty it by inserting a tube several times a day.
Continent Cutaneous Urinary Diversion (Indiana Pouch, Koch Pouch)
How it works:
- Surgeons use part of your intestine to create a storage pouch
- They make a valve to prevent leaking
- A small opening (stoma) is created on your belly
- You drain urine by inserting a catheter through this opening
Benefits:
- No external bag needed
- Better body image
- Fewer skin problems
- More freedom in daily life
Drawbacks:
- More complex surgery with higher risk of complications
- Requires good hand skills to use the catheter
- Sometimes hard to insert the catheter
- Possible stone formation
Orthotopic Neobladder
This creates a new bladder that connects to your urethra, allowing more natural urination.
How it works:
- Surgeons create a new bladder from a piece of intestine
- They connect your ureters to this new bladder
- The new bladder attaches to your urethra
- You learn to pee by relaxing your muscles and using your belly muscles
Benefits:
- Most natural option
- No external devices
- Natural-feeling urination
- Better body image and quality of life
Drawbacks:
- Complex surgery with longer operation time
- Risk of leaking urine (especially at night)
- Some people need to use catheters sometimes
- Not right for everyone
Choosing the Right Diversion
Several factors help decide which type is best for you:
- Age: Younger patients might prefer continent diversions or neobladders
- Physical ability: You need good hand skills for some types
- Kidney health: Poor function may rule out certain options
- Disease status: Cancer in the urethra may prevent neobladder creation
- Bowel health: Previous intestinal problems may limit options
- Your preference: Your choice matters after learning about all options
- Surgeon skill: Complex diversions require special expertise
Getting Ready for Surgery
Before urinary diversion surgery, you’ll need to:
- Get medically ready: Treat other health issues and improve your nutrition
- Prep your bowels: Clean out your intestines before surgery
- Mark stoma site: A special nurse will mark the best spot for your stoma
- Learn about care: Get info about post-surgery care and equipment
- Address concerns: Talk about body image and lifestyle changes
- Complete tests: Blood work and scans to ensure you’re ready
Care After Surgery
After your urinary diversion surgery, you’ll need good care:
Right After Surgery
- Pain control: You’ll get medicine to manage pain
- Monitoring: Staff will check your vital signs and fluid levels
- Temporary tubes: These help healing where connections were made
- Moving around: Early walking prevents blood clots
- Eating: You’ll slowly return to normal foods
Long-term Follow-up
- Regular check-ups: To monitor kidney function and catch problems early
- Imaging tests: Ultrasounds or CT scans to check your urinary tract
- Blood tests: To check for imbalances and kidney function
- Scope exams: For neobladders and some continent diversions
- Stoma care: For patients with external openings
Possible Problems
Urinary diversion can lead to several complications:
Early Problems
- Bleeding: May need blood transfusion or more surgery
- Infection: In the wound, urinary tract, or abdomen
- Leaking: Where connections were made
- Bowel blockage: Due to slow gut function or scarring
- Blood clots: In legs or lungs
Later Problems
- Stoma issues: Narrowing, bulging, or hernia
- Infections: More common with all types of diversions
- Stone formation: Especially in internal pouches
- Chemical imbalances:
- Electrolyte problems
- Acid-base disturbances
- Vitamin B12 deficiency (in some cases)
- Pouch rupture: Rare but serious in continent diversions
- Leaking urine: In neobladders, especially at night
- Cancer return: At connection sites or in the new structures
Life After Urinary Diversion
Research shows varied effects on quality of life:
- Physical function: Gets worse at first but improves over time
- Body image: Often better with continent diversions and neobladders
- Sex life: May change due to nerve effects during surgery
- Social life: Most people report few limits after adjusting
- Overall happiness: Most report good quality of life after adjustment
Good education, setting realistic expectations, and counseling before surgery greatly affect satisfaction afterward.
New Advances
Recent improvements in urinary diversion include:
- Robot-assisted surgery: More precise with faster recovery
- Tissue engineering: Research into growing bladder tissue from your own cells
- Better ostomy products: Improved adhesives and odor control
- Enhanced recovery plans: Standard care paths that reduce hospital stays
- New techniques: Modified approaches to reduce complications
Special Cases
Children
Kids with birth defects may need urinary diversion. Special concerns include:
- Growth potential as they develop
- Impact on self-image and development
- Long-term body chemistry effects
- Need for revision surgery as they grow
Older Adults
Seniors face unique challenges:
- Higher risk of complications
- Hand dexterity concerns
- Mental ability to manage care
- Life expectancy affecting procedure choice
People with Nerve Disorders
Those with spinal cord injuries need special planning:
- Assessment of hand function
- Consideration of caregiver help
- Modified techniques for wheelchair users
Education and Support
Good education and support are key to success:
- Learning before surgery: Understanding what to expect
- Skills training: Learning stoma care or self-catheterization
- Support groups: Meeting others who’ve had similar procedures
- Online resources: Trusted websites and forums
- Professional help: Access to special nurses and doctors
Common Questions
How will this affect my daily life?
Most people return to normal activities after recovery. You may need to plan for catheter use or bag changes. Swimming and exercise are possible with proper planning.
Will I need to change my diet?
Some diet changes may help. People with continent diversions should drink plenty of fluids. Some may need vitamin B12 supplements. Certain foods might increase odor or irritate stoma skin.
Will people notice my stoma or bag?
Modern ostomy supplies are discreet and hide under clothing. Low-profile designs work well for swimming or intimate moments. Continent diversions have just a small, flat opening that needs no external bag.
Can I travel with urinary diversion?
Yes, travel is possible with planning. Bring extra supplies, a doctor’s note for security checks, and info about medical facilities at your destination.
Will insurance cover my supplies?
Most U.S. insurance plans cover ostomy supplies and catheters, but coverage varies. Medicare Part B covers ostomy supplies with a prescription. Check with your insurance provider.
Can urinary diversion be reversed?
Most urinary diversions are permanent. Temporary diversions might be done for specific conditions, but standard diversions after bladder removal usually can’t be reversed.
Conclusion
Urinary diversion is a major surgery that can greatly improve life for people with bladder problems. Each type has pros and cons. Advances in surgery and care continue to improve results.
The best choice depends on your medical condition, lifestyle, preferences, and ability to manage care. With proper education, support, and follow-up, most people adapt well to life with urinary diversion.
Research continues, especially in tissue engineering and less invasive approaches. The future looks promising for even better options for those needing urinary diversion.