Continent Urinary Diversion: An Overview

What Is Continent Urinary Diversion?

There are two kidneys in the human body; their function is to filter blood and remove excess fluids and waste from the body. The formed urine travels down from the ureters to the urinary bladder, where it is stored unless one needs to pass urine. If the bladder is injured or diseased, one might not be able to pass urine usually. Then continent urinary diversion comes into the picture. It is a surgical procedure that forms a new path to remove urine when the urinary system is damaged or when there is a need to bypass a diseased area in the urinary system.

Why Does One Need Continent Urinary Diversion?

• Bladder cancer.

• Damage to the bladder nerve due to congenital disabilities like spina bifida, spinal cord injury, or multiple sclerosis.

• Chronic bladder inflammation results from severe forms of interstitial cystitis, recurrent urinary tract infections, or chronic urinary retention.

• Conditions putting pressure on the urethra or the ureter(s).

• Chronic retention of urine due to an enlarged prostate or benign prostatic hyperplasia.

• Radiation treatment results in permanent damage to the urinary bladder.

• Urinary incontinence cannot be managed with other treatments.

• Injury to the urinary bladder, urethra, or pelvis.

• The presence of tumors in the genitourinary tract or the tissues or organs near it.

• Kidney or bladder stones.

What Is the Aim of Continent Urinary Diversion?

Continent urinary diversion aims to replicate a normal lower urinary tract for urine storage, draining, continence, and preservation of kidney function.

Are There Any Investigations Needed Before the Surgery?

• Physical History: A comprehensive history of the patient involves any evidence of past abdominal or pelvic surgery, irradiation, intestinal resection, kidney failure, diverticulitis (inflammation of the small pouches in the food tract), or inflammatory bowel disease.

• Complete Blood Count: A complete blood count is needed to evaluate kidney function.

• Imaging Techniques: Imaging diagnostic techniques should be done to evaluate the presence of any kidney tissue scarring, stones, or hydronephrosis (swelling of the kidney/s).

• Voiding Cystometrogram and Cystoscopy: This procedure should be performed to evaluate the structure of the urinary bladder, urethra, and the mechanism of the bladder's sphincter.

• Scan: Computer tomography scan and colonoscopy can be advised to evaluate the anatomy of the intestines.

Individuals undergoing continent urinary diversion should undergo these preoperative diagnostic investigations and counseling. They should also be informed about the complications involving the surgery, such as the impact on their sexual life, general lifestyle, and body image.

How Is Continent Urinary Diversion Surgery Carried Out?

Continent urinary diversion collects and stores urine within the body until one drains through a catheter or passes urine through the urethra. Then the urine flows via the ureters from the kidneys and is stored in a pouch created from a part of the intestine. The different types of continent urinary diversion include:

• Continent Cutaneous Reservoir: The surgeon uses a part of the intestine to create a pouch or reservoir internally to hold the urine. The pouch is then placed within the abdomen. The ureters are attached to the pouch, and the pouch is attached to a stoma (an opening) in the abdomen. The urine flows through the ureters into the pouch, where it is stored unless one drains it with the help of a catheter into the stoma. The stoma is the last part of the channel connecting to the reservoir. The track or path has a valve that prevents urine from leaving the body unless a catheter is inserted. This path is created from a part of the intestine or by using the appendix.

• Bladder Substitute, or Neobladder: In this procedure, the surgeon uses a piece of the intestine to create a pouch internally, known as a bladder substitute or neobladder. The new bladder is placed in the pelvis. The ureters are attached to the neobladder, and the bladder substitute is attached to the urethra. The urine flows through the ureters into the neobladder, and one passes urine through the urethra.

The kind of continent diversion surgery one has depends on various factors such as age, medical history, surgeries, mobility, irradiation or cancer therapy, ability to use a catheter, or the individual's preference.

How Is Life After Continent Urinary Diversion?

With time the individual gets used to the diversions and also learns to take care of it. After the surgery, a nurse teaches the patient to manage and take care of the urinary diversion. The patient should wash his hands before and after cleaning the diversion to avoid any bacterial contamination that could lead to a possible infection.

Emptying the Pouch: A tube or catheter is inserted through the stoma or the opening into the pouch. The nurse or doctor demonstrates it to the patient. In the beginning, the emptying is done every few hours until the pouch stretches. In the long run, one can leave the pouch for six hours without emptying it.

Washing the Pouch: The pouch needs to be washed as well. The intestinal tissues used to prepare the pouches continue to secrete mucous, a thick whitish slimy substance. It appears as threads in the urine, and if it is not washed, it can lead to infection. Therefore, the pouch needs to be washed many times a day. For this, sterile water or normal saline is put through the catheter used to drain the pouch with the help of a syringe. The skin around the opening or stoma should be cleaned and dried before and after one uses a catheter. The physician will give instructions about the emptying and washing of the pouches. One should follow their advice and consult them if need be.

For taking care of the bladder substitute or neobladder, the following steps should be followed:

• Empty the bladder substitutes every two to three hours during the day and every three to four hours at night for a couple of weeks after the surgery, eventually emptying every four to six hours during the day and once at night.

• The person should try sitting on the toilet to empty the bladder substitute.

• In case the substitute does not drain thoroughly, then a catheter can be used to empty the bladder.

• To build mucous in the bladder substitute, one needs to clean it by washing it with a standard saline solution.

• Urine might leak during the first six to twelve months after the surgery. It is common at night. Disposable briefs and pads can be used in such cases.

What Are the Complications Involved With Continent Urinary Diversion Surgery?

Continent urinary diversions can get infected with bacteria and cause urinary tract infections. Urinary tracts infections can cause:

• Fever.

• Chills.

• Vomiting.

• Loss of appetite.

• Nausea.

• Pain in the back or sides (flank).

• Increased frequency of urination.

• Painful urination.

• Cloudy, dark, or foul odor urine.

The healthcare provider should be contacted at once if one develops such symptoms. In addition, one should be hydrated enough to prevent developing the infection.

Getting Back to the Routine-

Several individuals who underwent the continent urinary diversion surgery can return to their routine activities and exercises only after the doctor's consent. Strenuous exercises and heavy lifting should be avoided till the body heals completely. If one's job requires lifting heavy objects, the doctor might suggest wearing some protective padding.

To conclude, continent urinary diversion surgery is a procedure that is carried out to create a new pathway for urine drainage in case a structure of the urinary tract system is damaged. There are a few ways by which the surgery can be performed. First, it is a safe procedure with negligible risk, provided proper care is taken post-surgery. Living with a diversion needs adjustments, but it might get discouraging for some. In that case, talking with friends, family, near or dear ones, or a doctor might help.