Urinary diversion operations

If your bladder is removed, the surgeon will make a new way for you to pass urine. This is called a urinary diversion. There are different ways to do this:
  • Urostomy (ileal conduit) – this is the most common type of operation. The surgeon attaches the ureters to a tube that opens out on your tummy. You will have a bag over the opening that will collect urine. You will need to empty the bag regularly.
  • Bladder reconstruction (neobladder) – this is when the surgeon makes a new bladder using a piece of your bowel. You still pass urine through the urethra. You will need to learn a new way of emptying your bladder by flexing your tummy muscles.
  • Continent urinary diversion – this is similar to a urostomy but the surgeon uses a piece of your bowel to make an internal pouch instead. You will empty the urine from the pouch using a catheter.

Your nurse will show you how to manage your urinary diversion. With time, it will become easier to manage.

Types of urinary diversion operation

When your bladder is removed, your surgeon will make a new way for you to pass urine. This is called a urinary diversion.

There are different types of operation. Your surgeon and nurse will talk to you about what is involved. They can advise you which type of urinary diversion is most suitable for you.

These operations are only carried out by specialist surgeons. Some people may need to travel to a different hospital to have their operation.

Urostomy (ileal conduit)

This is the most common type of operation. Your urine will be collected in an external bag, which you stick onto your tummy (abdomen).

During the operation, the surgeon removes a section of your small bowel (ileum) to use. They join the two ureters to one end of it. They bring the other open end of bowel out through a small opening in the skin of your tummy. This is called a stoma.

The ureters carry urine from your kidneys to the piece of bowel. The piece of bowel acts as a channel (conduit) to take the urine to the surface of your tummy. This is why this operation is sometimes called an ileal conduit.

You place a flat, watertight bag over the stoma to collect your urine. It’s kept in place with adhesive. The bag will fill with urine, and you’ll need to empty it regularly. A specialist nurse will show you how to take care of it. We have more information about living with a urostomy.

Urostomy (ileal conduit)
Urostomy (ileal conduit)

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Bladder reconstruction (neobladder)

The surgeon makes a new (neo) bladder using a piece of your bowel which they connect to your urethra. The new bladder stores urine and you pass urine through your urethra as before.

To empty your new bladder, you need to flex your tummy muscles. You do this by holding your breath and pushing down into your tummy. You have to do this regularly, as you don’t have the nerves that tell you when your bladder is full.

Some people may also need to pass a catheter into their urethra to completely empty their new bladder. This is called self-catheterisation. Your specialist nurse will teach you how to do this.

Sometimes the surgeon may not able to make the new bladder during surgery. If this happens, they will form a urostomy instead. Your surgeon will explain the risk of this before surgery.

Neobladder (bladder reconstruction)
Neobladder (bladder reconstruction)

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Continent urinary diversion

This is similar to a urostomy, but you don’t need an external bag to collect your urine. Your surgeon uses a piece of your bowel to make an internal pouch that stores urine inside your tummy. They attach your ureters, which carry urine from your kidneys, to the pouch. The surgeon uses a piece of tissue, for example your appendix, to make a tube that connects the pouch to your tummy wall. They make a small opening (stoma) from this tube on the tummy wall. This type of stoma lies flat against the skin and isn’t raised.

You empty urine from the pouch through the stoma using a tube (catheter). This is called self-catheterisation. You need to do it about five or six times a day. A specialist nurse will show you how to do this. We have more information about managing a continent urinary diversion.

Continent urinary diversion
Continent urinary diversion

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Preparing for your urinary diversion

A specialist nurse will talk to you about managing your urinary diversion before you have surgery. They will also arrange to visit you after your surgery.

Before your operation, the nurse or doctor will carefully plan the position of the stoma. They will do this even if you are having a bladder reconstruction, just in case they need to create a urostomy. They make a mark on your tummy so that your surgeon knows the best position for the stoma.

A stoma is often on the right side of your belly button (navel). But it may be positioned on the left side if you are left-handed. Sometimes, the position can be suited to a person’s needs. For example, a right-handed golfer may prefer a left-sided stoma so it doesn’t interfere with playing golf.

For a continent urinary diversion, the stoma is positioned where you can see it and easily put a catheter into it.

The thought of urinary diversion surgery may seem overwhelming. Asking all the questions you want to before your operation can help. Your doctor or nurse may be able to arrange for you to meet someone who already has a urinary diversion before your surgery. You will have a specialist nurse who will help you learn to look after it.

With time and practice, looking after your urinary diversion will get easier. We have more information about living with a urinary diversion.

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