Urinary diversion is a surgical technique used to create a new pathway for urine to exit the body, often following the removal of the bladder as part of treatment for bladder cancer. In addition to bladder cancer, urinary diversion may be necessary in cases of severe trauma, congenital abnormalities, or other conditions that compromise the normal urinary tract, such as infections or chronic inflammation. The procedure can be either temporary or permanent, depending on the patient’s condition and treatment plan. There are several types of urinary diversions, each tailored to the patient’s needs. Incontinent diversions involve creating a stoma, an opening on the abdominal wall, where urine is redirected into an external collection bag. Common techniques for this include the use of an ileal or colonic conduit, which repurposes a segment of the intestine to transport urine from the kidneys to the stoma. In contrast, continent urinary diversions are designed to allow the patient greater control over urine storage and release. These include creating a neobladder, which is constructed from intestinal tissue and allows the patient to void urine through the urethra. When the urethra is not functional, a continent cutaneous reservoir, such as an Indiana pouch, can be formed, enabling the patient to drain urine via a catheter through a small abdominal opening.

Types

Nephrostomy A nephrostomy or percutaneous nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system ( renal pelvis). It is an interventional radiolo ...

from the

renal pelvis The renal pelvis or pelvis of the kidney is the funnel-like dilated part of the ureter in the kidney. It is formed by the convergence of the major calyces, acting as a funnel for urine flowing from the major calyces to the ureter. It has a mucous ...

Urostomy A urostomy is a surgical procedure that creates a stoma (artificial opening) for the urinary system. A urostomy is made to avail for urinary diversion in cases where drainage of urine through the bladder and urethra is not possible, e.g. after ex ...

from more distal origins along the urinary tract, with subtypes including: **

Ileal conduit urinary diversion An ileal conduit urinary diversion is one of various surgical techniques for urinary diversion. It has sometimes been referred to as the Bricker ileal conduit after its inventor, Eugene M. Bricker. It is a form of incontinent urostomy, and was d ...

(Bricker conduit) **

Indiana pouch An Indiana pouch is a surgically-created urinary diversion used to create a way for the body to store and eliminate urine for patients who have had their urinary bladders removed as a result of bladder cancer, pelvic exenteration, bladder exstrop ...

Neobladder to urethra diversion Urinary diversion is a surgical technique used to create a new pathway for urine to exit the body, often following the removal of the bladder as part of treatment for bladder cancer. In addition to bladder cancer, urinary diversion may be necessa ...

Ureteroenteric anastomosis

A common feature of the three first, and most common, types of urinary diversion is the ureteroenteric anastomosis. This is the joining site of the

ureters The ureters are tubes composed of smooth muscle that transport urine from the kidneys to the urinary bladder. In an adult human, the ureters typically measure 20 to 30 centimeters in length and about 3 to 4 millimeters in diameter. They are lin ...

and the section of intestine used for the diversion. The ureteroenteric anastomosis can be created in a number of different ways. There is the option of a refluxing or a non-refluxing type, and the two ureters can be joined into the intestinal segment either together or separately. The non-refluxing type has been associated with higher incidence of ureteroenteric anastomosis stricture, and there is doubt whether it has any advantages over the refluxing type. Therefore, many surgeons prefer the refluxing type which is simpler and apparently carries a lesser degree of complications. Refluxing techniques include the Wallace and Wallace II and the

Bricker end-to-side anastomosis A surgical anastomosis is a surgical technique used to make a new connection between two body structures that carry fluid, such as blood vessels or bowel. For example, an arterial anastomosis is used in vascular bypass and a colonic anastomosis ...

. Non-refluxing techniques includes the Le Duc technique.

Complications

Complications include

incisional hernia An incisional hernia is a type of hernia caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are often also classified as ventral herni ...

, neobladder-intestinal and neobladder-cutaneous

fistula In anatomy, a fistula (: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other h ...

s, ureteroenteric anastomosis stricture, neobladder rupture and mucous formation. Ureteral diversion can lead to

normal anion gap acidosis Normal anion gap acidosis is an acidosis that is ''not'' accompanied by an abnormally increased anion gap. The most common cause of normal anion gap acidosis is diarrhea with a renal tubular acidosis being a distant second. Differential diagnosis ...

References

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External links

eMedicine: Urinary Diversions and Neobladders
{{Urologic surgical and other procedures Urologic surgery

Types

Ureteroenteric anastomosis

Complications

See also

References

External links