Urinary diversion surgery creates a new way for urine to exit your body after bladder removal. There are three different surgical options for urinary diversion. Two of them give you control over when you pass urine.

An estimated 82,290 new diagnoses of bladder cancer will be made in the United States in 2023, according to the American Cancer Society. Many of these bladder cancers will be treated with some form of surgery.

Invasive bladder cancer, which is when cancer has invaded the muscles of the bladder wall, is often treated with a radical cystectomy. This involves the removal of the entire bladder.

Individuals who’ve had their bladder removed will need to have a way for urine to leave their body. The type of surgery that accomplishes this is called urinary diversion surgery.

Urinary diversion surgery is a type of surgery that creates a way for urine to leave your body. It’s done after surgery to remove your bladder.

Urinary diversion surgery is categorized as either incontinent or continent:

Incontinent urinary diversion: This type of surgery eliminates control over when you urinate. The urine continuously passes from an opening that’s made in your abdomen, called a stoma, and into a collection pouch outside of your body.

Continent urinary diversion: This type of surgery gives you some control over when you urinate. The surgeon creates a pouch inside of your body to hold your urine. You can then drain this pouch at regular intervals as it fills.

Generally speaking, three types of urinary diversion are used after radical cystectomy for bladder cancer. These are:

  • ileal conduit diversion (incontinent urinary diversion)
  • neobladder (continent urinary diversion)
  • continent cutaneous diversion (continent urinary diversion)

Candidates for urinary diversion

Most people are eligible for all three urinary diversion options. Individual factors do play a role in the type of urinary diversion selected. These include:

  • age
  • level of physical and cognitive function
  • extent of the cancer
  • the presence of preexisting conditions, specifically those affecting your urinary tract, liver, or bowel
  • personal preference

For example, ileal conduit diversion is the simplest type of urinary diversion, both as far as the procedure and for maintenance afterward. As such, it may be recommended for people who are older or have lower physical or cognitive function.

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Ileal conduit diversion is a type of incontinent urinary diversion. In an ileal diversion, a surgeon removes a 6- to 8-inch portion of your small intestine.

Your intestine will be reconnected and the removed portion will be attached to your ureters, the tubes that normally move urine from your kidneys to your bladder. This is called an ileal conduit.

Urine can drain from your kidneys, through the ureters, and into the ileal conduit. One end of the ileal conduit is connected to the skin of a stoma in your abdomen. Urine drains through the stoma and into a collection pouch outside of your body.

A neobladder is a type of continent urinary diversion. A surgeon will use a part of your small intestine to create a new bladder, called a neobladder. Your ureters will then be connected to the neobladder so that urine can drain into it.

The bottom of the neobladder is attached to your urethra. That means this type of urinary diversion allows you to pass urine out of your urethra as you would have done before your cystectomy.

It’s important to note that you won’t have the urge to urinate when your neobladder is full. This means that you’ll need to urinate on a schedule to prevent leakage of urine. You may also need to insert a catheter to help urine to drain.

Continent cutaneous diversion is another type of continent urinary diversion. A pouch is made from a piece of tissue, typically from your intestines, and is attached to your ureters. Valves help to prevent urine from backing up into your kidneys.

There are several ways to create a pouch for continent cutaneous diversion. The variation is in the type of tissue that’s used to make the pouch. Often, tissue from the small or large intestine is used.

Regardless of the method used, the other end of the pouch is attached to a stoma. Instead of allowing urine to drain continuously through the stoma and into a collection pouch, a one-way valve is placed at the stoma.

This valve allows urine to be stored in the newly created pouch. You can drain it periodically throughout the day by placing a catheter into the valve. You won’t have a collection pouch outside of your body like in ileal conduit diversion.

What are the risks associated with urinary diversion surgery?

Some of the potential risks associated with urinary diversion surgery may include:

Generally speaking, ileal conduit diversion is associated with fewer side effects. Your surgeon will outline the risks associated with your specific type of urinary diversion before your surgery.

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A 2022 study looked into quality of life in people who had a radical cystectomy and either an ileal conduit diversion or a continent cutaneous diversion. Overall, there weren’t large decreases in quality of life reported. Specifically, researchers found that:

  • While physical function scores initially decreased in the 6 months after surgery, they eventually stabilized or returned to baseline.
  • Overall quality of life improved from baseline by 6 months after surgery.
  • The only areas that remained low or decreased were sexual function and body image, respectively.

Information is key when selecting a urinary diversion method. A 2020 study of people with ileal conduit diversion or a neobladder found that those who felt well-informed about their surgical options had less regrets, regardless of the type of urinary diversion used.

As such, be sure to talk with a doctor about all of your urinary diversion options before your cystectomy. They can give you more details about how each procedure works and the risks and benefits associated with each.

Urinary diversion is used after a radical cystectomy. It creates a new way for urine to leave your body after your bladder is removed.

There are three types of urinary diversion procedures that can be performed following radical cystectomy. Two of these allow you to control when you pass urine while the another doesn’t.

Each type of urinary diversion comes with its own pros and cons. Additionally, some types of urinary diversion may not be recommended for you based off of individual factors.

Be sure to have a detailed conversation with your doctor about your options for urinary diversion and what may be a good fit for you.