UROLOGY · CONDITIONS
Urinary Diversion
Surgical rerouting of urine flow following bladder removal , personalised reconstruction using the ileum to restore urinary function with the best quality of life.
ABOUT THIS CONDITION
What is Urinary Diversion?
Urinary diversion is performed after radical cystectomy for bladder cancer or when the bladder is rendered non-functional by disease. The three main options , ileal conduit (external bag), orthotopic neobladder (voiding through the urethra), and continent cutaneous reservoirs , each have distinct advantages and trade-offs that must be discussed in detail with the patient before surgery. Dr. Vipin provides comprehensive, unbiased pre-operative counselling on all diversion options, involving specialist stoma nurses for conduit planning and ensuring each patient fully understands and chooses the reconstruction that best fits their life , oncological safety and quality of life both being given equal priority.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Muscle-invasive bladder cancer (most common indication)
- BCG-unresponsive high-risk non-muscle-invasive bladder cancer
- Radiation cystitis causing intractable haemorrhage or pain
- Neurogenic bladder with irreversible high-pressure dysfunction
- Refractory interstitial cystitis after all other treatments fail
- Trauma or congenital absence of the bladder
CLINICAL DETAILS
Key Facts
Most reliable , urine drains continuously into an external bag. No self-catheterisation needed.
Internal reservoir anastomosed to the urethra , voiding through the native urethra without a bag.
Catheterisable stoma to the umbilicus , no bag, no urethral voiding. Clean intermittent catheterisation
Recommended for patients who have had their bladder removed due to cancer but are not candidates for a neobladder
Informed choice is essential , no diversion type is universally superior. Patient preference determines selection.
Pre-operative stoma marking and counselling by a specialist nurse , mandatory for conduit patients.
HOW WE TREAT IT
Treatment Approach
Orthotopic Neobladder (Studer / W-Pouch)
A large, low-pressure ileal reservoir is constructed and anastomosed to the urethra , providing continent voiding through the native urethra without a stoma. The Studer and W-pouch are the most widely performed neobladder configurations worldwide.
- 1
Pre-operative Counselling
All diversion types explained in full. Stoma nurse marks conduit site. Patient selects the reconstruction that best fits lifestyle and medical suitability.
- 2
Radical Cystectomy
Bladder and pelvic lymph nodes removed. Ureters divided. Urethra assessed for neobladder suitability , requires urethral sphincter integrity.
- 3
Diversion Construction
Ileal conduit: ureters to isolated ileal segment to stoma. Neobladder: detubularised ileal pouch anastomosed to urethra. Indiana Pouch / Mitrofanoff built for appropriate candidates.
- 4
Recovery & Follow-up
Hospital stay 5–7 days. Stoma appliance fitting and CIC technique taught before discharge. Renal function, vitamin B12, and upper tract imaging monitored annually.
AVAILABLE TREATMENTS
Treatment Options
Ileal Conduit (Bricker's)
Permanent urostomy using an isolated ileal segment , the most reliable and widely performed urinary diversion, requiring an external urostomy bag.
Orthotopic Neobladder (Studer / W-Pouch)
Ileal reservoir anastomosed to the urethra , continent voiding without a stoma. Requires an intact urethral sphincter.
Mitrofanoff Procedure
Appendix or tapered ileum used as a continent catheterisable channel to the umbilicus , no bag, no urethral voiding required.
Indiana Pouch (Continent Cutaneous)
Right colon and terminal ileum reservoir catheterised through a flush abdominal stoma , continent, no external appliance.
COMMON QUESTIONS
Frequently Asked
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