After surgical removal of the bladder (radical cystectomy), reconstructive surgery is necessary to provide a new way to store and empty urine. This is called a urostomy, and three options are available. Learn more about each option and discuss with your doctor your preferences regarding urine control. The type of urinary diversion you have will also depend on this input and your medical condition.
Option 1: Ileal conduit
To create this common reconstruction option, the surgeon will isolate a piece of intestine while maintaining the blood vessels that supply the intestine. The surgeon will then attach the ureters (tubes through which urine normally flows from the kidneys to the bladder) to one end of this segment of intestine. The other end will be attached to an incision in your abdominal wall to form a stoma (a surgically-made hole). The surgeon will close the separation in your intestine and all other incisions with sutures (stitches) or staples.
Urine flows continuously through this ileal conduit to the outside, collecting in a small bag (an ostomy bag) attached to the stoma that is emptied periodically. The pouch will lie flat against the body and can be covered with your clothes. This surgery is known as an incontinent diversion because you no longer control the flow of urine from the body.
Your surgeon may insert a small tube(s) into the surgical site to allow any excess fluids to drain during the recovery process. To help drain urine while you heal, stents (small mesh tubes) may be placed through the stoma into the ureters.
Option 2: Continent cutaneous pouch
A continent urinary diversion allows you to have some control over the flow of urine out of your body. To create this internal storage container for urine, the surgeon uses a section of intestine that is attached to your ureters to create a urine storage pouch within the body. This pouch, also referred to as an Indiana pouch, is connected to the ureters on one end and to a stoma on the other. You will drain the pouch by inserting a catheter (small thin tube) through the stoma.
After any stents and catheters are removed, you can empty urine by inserting a catheter through the stoma and draining the urine into the toilet. The stoma and surrounding skin must be washed and dried before and after each catheterization. Initially, the pouch will need to be drained every two to three hours, but over time, you should be able to drain the pouch every four to six hours.
Option 3: Orthotopic bladder (neobladder)
A neobladder, also referred to as a substitute or new bladder, is created using a portion of your intestine. It is a type of internal reservoir for storing urine. One end is attached to the ureters and the other end to the urethra (tube through which urine exits the body). Urine would leave your body in the regular way. An external collection bag is not needed. Over time, you may be able to regain some control of your urination.
To help drain urine while you heal, a catheter and/or stents (small mesh tubes) may be placed into the neobladder through the small incision in the abdomen.
After the catheters are removed, an incontinence pad and an absorbent pad on the bed at night will be necessary until your urinary control improves. Your doctor will give you a urination schedule, which usually begins with urinating every two hours. Bearing down (the Valsalva maneuver), as if having a bowel movement, will cause urination. You may be asked to insert a catheter twice a day after urinating to see if the bladder is emptying completely. The catheter must be irrigated during one of the catheterizations to remove mucus produced by the piece of intestine used to make the neobladder.
Living With a Stoma
A stoma is an opening in your abdomen that is connected to your urinary system. A barrier ring may help fill in any gaps. It will be attached to a pouch that lies against your body to collect your urine.
As you get used to the idea of a stoma, keep in mind that most people are able to resume their daily activities – and even wear the same clothes – without many adjustments. Your ostomy nurse will be available to answer your questions. In the meantime, these suggestions may help:
- Always wash your hands with soap and water before and after caring for your stoma and pouch.
- Protect your skin by using the right size pouch and skin barrier opening.
- Change the pouch regularly to avoid leaks and skin irritation.
- Clean the skin around the stoma with water. Pat the skin dry before putting on the skin barrier or pouch.
- You may need to shave the area around your pouch. Hair can prevent the skin barrier from sticking.
- The pouches include filters that should prevent odors. Using fragrance drops or sprays may give you extra confidence.