What is urinary diversion?

Urinary diversion refers to the redirection of urine flow by creating an alternative pathway in the urinary system, bypassing the usual structures. This procedure becomes necessary in cases where the bladder ceases to function properly or requires removal due to conditions like cancer or injury. The diverted urine can be directed either to a substitute bladder known as a "neobladder" or through an abdominal wall opening called a "stoma."

When is a urinary diversion indicated?

A urinary diversion procedure is indicated in the following situations:

• Bladder Dysfunction: When the bladder fails to function properly, leading to issues such as urinary incontinence (inability to control urine flow), recurrent urinary tract infections, or bladder emptying difficulties.
• Bladder Removal: In cases where the bladder needs to be surgically removed due to bladder cancer, extensive bladder damage from trauma, or other conditions that make bladder preservation impossible.
• Birth Defects: Certain individuals have innate irregularities in their urinary tract, such as bladder exstrophy or neurogenic bladder, which might require the implementation of urinary diversion techniques in order to effectively manage urine elimination.
• Inflammatory Conditions: Chronic inflammatory conditions like interstitial cystitis, where the bladder wall becomes severely inflamed and causes debilitating symptoms, may require urinary diversion as a last resort.
• Pelvic Surgery: Certain pelvic surgeries, such as extensive gynaecological procedures or surgeries involving the lower gastrointestinal tract, may require temporary urinary diversion to protect the healing tissues or facilitate post-operative recovery.

What does urinary diversion entail?

The process of urinary diversion entails surgically constructing an alternate route through which urine can exit the body in situations where the usual urinary structures are bypassed or removed. The specific procedure can vary depending on the individual's condition and needs. Here are the two main types of urinary diversion:

• Cutaneous Urinary Diversion:
• Ileal Conduit: In this procedure, a small segment of the small intestine (ileum) is used to create a conduit. One extremity of the conduit is linked to the ureters, responsible for transporting urine from the kidneys, while the other extremity is externally brought out through a small aperture in the abdominal wall, known as a stoma. A urinary collection pouch is affixed to the stoma to gather and contain the urine.
• Continent Urinary Diversion:
• Neobladder: In this procedure, a new reservoir or "neobladder" is created from a section of the intestine or other suitable tissue. The neobladder is connected to the urethra, allowing the individual to empty urine through the natural passage. With the neobladder, control over urination is restored, and a person can typically void urine voluntarily.
• Continent Cutaneous Reservoir: This procedure involves creating a reservoir from a segment of the intestine, similar to the However, instead of connecting it to the urethra, a small opening or stoma is created on the abdominal wall, which is then catheterised intermittently to empty the reservoir.

The selection of the particular urinary diversion technique is contingent upon several factors, such as the patient's general well-being, underlying condition, personal preferences, and the proficiency of the surgeon. Prior to the surgical procedure, the healthcare team will offer comprehensive guidance on stoma care, if applicable, as well as the management of any necessary urinary appliances or catheterisations. After the surgery, consistent follow-up appointments and continual care are crucial to guarantee the individual's well-being, comfort, and adaptation to the urinary diversion.