What Is Urinary Diversion?
Urinary diversion is a procedure that surgically provides a new pathway for the flow of urine outside the body when there is a block in the urine flow or when there is a pathology in the urinary tract. The diseased area is bypassed, and the urine is made to exit the body. The urinary system helps in draining out toxins and extra fluid through urine.
The urine flows through the kidneys, ureters, and bladder and exits the body through the urethra. When the urine does not normally exit the body, it builds up in the ureters, bladder, or kidneys. The build-up of urine causes pain, urinary stones or calculi, urinary tract infections, damage to the urinary tracts, or kidney failure. The build of urine in the body can be life-threatening if left untreated.
What Is the Need for Urinary Diversion?
The following conditions require urinary diversion:
1. Bladder cancer is one most common reasons for urinary diversion, as the entire bladder is removed through cystectomy.
2. Congenital disabilities such as:
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Spina bifida.
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Spinal cord injury.
These congenital disabilities cause nerve damage to the bladder
3. Chronic, long-lasting inflammation of the bladder caused due to:
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Interstitial cystitis.
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Recurrent urinary tract infections.
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Chronic urinary retention.
4. Outside pressure to the urethra or ureters.
5. Chronic urinary retention is caused by the following:
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Enlarged prostate or benign prostate hyperplasia.
6. Radiation therapy may cause severe damage to the bladder.
7. Urinary incontinence that has not responded to standard treatment regimens.
8. Trauma to the urethra, pelvis, or bladder.
9. Tumors in the genitourinary tract or the adjacent areas.
10. Calculi (urinary stones).
What Are the Types of Urinary Diversion?
The types of urinary diversion are:
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Cystostomy.
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Nephrostomy.
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Ureteral stent.
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Urostomy.
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Continent urinary diversion.
Bladder Catheterization: A catheter is inserted into the bladder to drain urine. The urine drained out gets collected in a bag outside the body. A catheter is a thin, flexible tube made of medical-grade materials. There are two types of catheters:
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A Foley catheter is inserted into the bladder through the urethra.
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A suprapubic catheter is inserted into the bladder below the belly button.
Catheters are placed for several days or weeks until the bladder heals from surgery. In some cases, the catheter may be permanent for draining urine. In cases of long-term catheterization, it should be changed at regular intervals.
Cystostomy: A tube is surgically placed into the bladder through the skin of the lower abdomen. This helps drain the urine from the bladder to a bag outside the body.
Nephrostomy: This procedure is similar to cystostomy. A radiologist or surgeon inserts a nephrostomy tube through the skin of the back to the kidney. A nephrostomy tube helps drain urine from the kidney to a bag outside the body. A nephrostomy is performed when the individual is diagnosed with kidney stones or suffering from blocked, inflamed, or narrowed ureters. Nephrostomy tubes are inserted based on the extent of the condition and the time taken by the body to heal.
Ureteral Stent: Ithelps drain urine from the kidney to the bladder. A ureteral stent is a flexible, thin tube inserted into the bladder by the health care provider. The ureteral stent is inserted into the ureter with the help of a cystoscope, placing one end in the bladder and the other in the kidney. A ureteral stent is used in conditions like a kidney stone, blocked ureters after surgery, tumor, or infection. Depending on the case, the stent may be placed temporarily or permanently. In cases of long-term, the stent should be changed at regular intervals.
Urostomy: A urostomy is an abdomen opening connected to the urinary tract, which helps drain the urine outside the body. The urine gets stored in a urostomy pouch which can be emptied at the individual's convenience. There are two types of urostomy:
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Ileal Conduit: In this procedure, a small part of the intestine is surgically removed from the intestine, creating a passage for the flow of urine. A stoma is created by attaching part of the intestine to the followed by attaching it to the opening in the abdomen. The urine then flows through the ureters, part of the intestine, and the stroma.
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Cutaneous Ureterostomy: In this procedure, the ureters are attached to the opening (stoma) in the abdomen.
Continent Urinary Diversion helps store and collect the urine before it is drained outside the body through a stent or a catheter. The internal pouch stores the urine and is prepared by a part of the bowel. There are two main types:
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Continent Cutaneous Reservoir: Prepare an internal pouch or reservoir with a part of the bowel to store urine. The ureters and stoma are attached to the internal pouch and then placed in the abdomen. The stoma is the end of the tube, which connects to the internal pouch.
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Neobladder: This is a bladder substitute where a small part of the creates an internal pouch to hold urine. The ureters are attached to the neobladder, and the neobladder is attached to the urethra. The neobladder is placed in the pelvis.
What Are the Postoperative Instructions After the Procedure?
Post-operative instructions include:
Neobladder: The bladder should be emptied every two to three hours during the day and three to four hours at night. Males are advised to sit on the toilet to create pressure while emptying the bladder.
Continent Cutaneous Reservoir: empty the pouch every two hours for two weeks after the surgery. The internal pouch should be regularly rinsed and flushed out. The skin around the stroma should be kept clean.
Urostomy Pouch: The pouch should be emptied when it is one-half or one-third full. The pouch should be changed at least one to two times a week.
Conclusion
Urinary diversion is a procedure that surgically provides a new pathway for the flow of urine outside the body when there is a block in the urine flow or when there is a pathology in the urinary tract. The post-surgical phase may be difficult to cope with, and individuals can seek help from the health care provider or join a support group not to get discouraged.
