SURGICAL OPTIONS FOR BLADDER DIVERSION

UOAA is an association of affiliated, nonprofit, support groups who are committed to the improvement of the quality of life of people who have, or will have, an intestinal or urinary diversion. Page 1 of 2

NTRODUCTION TO LADDER might be affected by the location of the pouch, talk to the I B doctor or the ostomy nurse. DIVERSION PROCEDURES If you do not understand the pouching system and how A radical (removal of the bladder) may be to manage it, ask for specific details. Some patients required for or . A report that they were not prepared well enough in bladder diversion may be required for neurogenic advance for the reality of a and a new method of bladder or congenital anomalies (birth defects). urinating. Often patients are so deeply concerned about their upcoming surgery that they do not absorb what has When faced with the need to have the bladder removed been said. or bypassed, there are three options for surgery: conventional (ileal conduit), continent urinary A special source of help is an ostomy visitor. The visitor reservoir (continent diversion) and neobladder. is a person who, like you, has had urostomy surgery and has successfully adapted to the changes that occur with Whichever choice is made, it must be remembered that a ostomy surgery. He or she can answer many of your major body function has been diverted and normal questions about day-to-day life. You may also benefit function will be altered as a result. The ultimate goal of from taking part in an ostomy support group. A support the surgery is to attain freedom from the disease and its group allows you to share your feelings and ask potential complications so that a normal lifestyle can be questions as you make progress with your recovery. You resumed. can also share your story with others who may benefit Not everyone is a candidate for the continent urinary from your experience. reservoir or neobladder, as there are factors other than the patient’s preference that must be considered. These considerations will be presented by the surgeon upon GLOSSARY OF TERMS examination of a person’s diagnosis, condition and surgical need. Interstitial cystitis Prior to your surgery, you should be well informed about Inflammation of the bladder wall of unknown cause. all of the possible options before making your decision. It is recommended that you seek advice from qualified Intubation healthcare professionals who have been trained and have Insertion of a special tube or through the experience with these surgeries. It is also recommended stoma into the reservoir to empty content. that you seek consultation before and after surgery with a certified Wound, Ostomy and Continence Nurse Neurogenic bladder (WOCN) or ostomy nurse. Bladder disorder due to abnormal nerve function. After determining your best surgical option, your doctor Pouchitis or ostomy nurse will explain the surgery and examine Inflammation in the reservoir. your abdomen to determine the best location for the stoma (for surgeries that include a stoma). For a Radical cystectomy conventional urostomy, you may be asked to wear a Removal of the bladder. sample pouch to make sure that the site chosen is on the flattest possible surface and that you are comfortable in all positions. If you have any hobbies or habits which SURGICAL OPTIONS FOR BLADDER DIVERSION

UOAA is an association of affiliated, nonprofit, support groups who are committed to the improvement of the quality of life of people who have, or will have, an intestinal or urinary diversion. Page 2 of 2

CONVENTIONAL UROSTOMY CONTINENT (ILEAL OR COLON CONDUIT) URINARY RESERVOIR NEOBLADDER

Procedure Procedure Procedure The bladder is removed or bypassed. The bladder is removed or bypassed. The bladder is removed or bypassed. A conduit is made from a section of An internal reservoir is constructed A urinary reservoir is made out of small intestine or colon. The from a segment of the small or large bowel and is attached to the to are attached to one end of the conduit. intestine and the ureters are implanted allow voiding by the normal route. The other end of the conduit is in a way to prevent reflux (back-up) of The patient voids by relaxing the brought through the abdominal wall to the kidneys. A valve to retain urinary sphincter while contracting the and fashioned into a stoma. urine is made within the reservoir. abdominal muscles.

Advantages Advantages Advantages • Established surgery; the long-term • A small patch is worn over the • Urinary continence. results are well understood. stoma. A pouching system is not • Normal urination route. needed. • No external collection pouch. Disadvantages • No back up of urine into the • Requires external pouching system kidneys. Disadvantages for collection of urine output. • Possible nocturnal leakage. • The pouch requires emptying every Disadvantages • Possible need of clean intermittent 3-4 hours. • You must intubate (insert tube self catheterization. through the stoma into pouch) to • The pouching system needs to be • The long-term results are not empty every 4-6 hours. replaced at regular intervals. known. • Potential urinary leakage. • Potential backup of urine into • Chance of pouchitis (inflammation kidneys resulting in • The long-term results are not of the reservoir). infections. known. • Chance of pouchitis (inflammation of the reservoir) which requires periodic irrigations and possible medication.