Once the bladder is removed, your surgeon needs to create a new way for the urine to drain from the kidneys to outside the body. The options are called “diversions.” In Canada, three diversions are common – ileal conduit, orthotopic neobladder and Indiana Pouch. You will want to discuss these with your surgeon to understand which is appropriate for you and why.
The surgeon will take a short segment of the ileum (part of the small intestine) to create a channel for the urine to pass out of the body. The remaining bowel is sewn back together. The two ureters from the kidneys which drain the urine are attached to this segment and an opening in the right side of the abdomen is created, called a stoma. A removable bag, called a urostomy pouch, is affixed to the skin surrounding the stoma to catch the continuous flow of urine.
Advantages: Shorter and relatively simple surgery, fewer potential complications, shorter segment of bowel re-purposed.
Disadvantages: Must always wear an external pouch to collect urine, possible skin irritation/breakdown around stoma, infections, body image issues, potential for odour, potential for leaks.
The surgeon will create a “new” bladder out of a longer segment of small intestine in the same place as the old, diseased bladder was. This neobladder will be attached to the ureters from the kidneys and also attached to the urethra so that voiding urine is done as before.
The neobladder is not a muscle like your original bladder was, and does not have the same “fullness” sensations as does a bladder, so you must learn how to “hold” your urine (become continent) and how to effectively empty it using the pelvic muscles.
Advantages: Near normal function, no body image issues, no external pouches, no odours.
Disadvantages: Incontinence (as some may never regain full control), the inability to empty the neobladder (some may need to use a catheter daily to empty the neobladder), longer surgery time, potential for restricted flow.
The surgeon will take a segment of large intestine and a small portion of the ileum to make an internal pouch into which the ureters flow. The short piece of small intestine is brought to the surface of the abdomen (the stoma). There is no external pouch and the stoma is very small, and can be covered with a bandage. A catheter inserted into the stoma is used several times per day to empty the pouch.
Advantages: No external pouch, no odours, no body image issues.
Disadvantages: Longer surgery time, the need for catheterization, possible risk of leakage from the stoma, scarring of the stoma making catherization difficult, stones in the pouch.
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