A surgical procedure to create a method for the storage and passage of URINE from the body after cystectomy (surgical removal of the BLADDER). Though most often necessary following cystectomy to treat BLADDER CANCER or invasive cancer of the pelvic region, urinary diversion may be necessary after traumatic injury to the bladder. Urinary diversion may also be a palliative treatment for inoperable bladder or pelvic cancer, diverting the flow of urine to overcome urinary obstruction. Urinary diversion may be continent (collects and contains urine within the body), which most people prefer when it is possible, or incontinent (collects a steady flow of urine in a bag outside the body).
When the urethra remains intact the urologic surgeon can fashion a substitute bladder, called a neobladder, from a segment of bowel (which has the ability to expand somewhat), attaching the ureters and the URETHRA. The neobladder allows the person to urinate naturally. However, the neobladder requires more frequent, and usually timed or scheduled, emptying as it lacks the distention ability and capacity of the native bladder as well as the nerves that activate the micturition REFLEX.
When the cystectomy also includes removal of the urethra, the surgeon generally chooses to craft a collection reservoir from a segment of SMALL INTESTINE that remains in the abdominal cavity, then create a valved opening through the abdominal wall into the reservoir. The person periodically inserts a catheter into the opening to drain the urine, usually every three to four hours, including through the night. Though not as natural as the neobladder, the catheter reservoir still permits urinary continence.
Incontinent urinary diversion is similar to the catheter reservoir, except the opening through the abdominal wall, called a stoma, lacks a valve. The person attaches an ostomy bag over the opening using special adhesive. Urine drains continuously into the bag, and periodically the person removes the full bag and replaces it with a clean, empty bag. The bags are small and unobtrusive beneath the clothing. The adhesive ensures there is no leakage of urine. A urostomy bag may require changing every six to eight hours. Surgeons use this method, called urostomy or ileal conduit, primarily when continent urinary diversion is not a viable option.
Urinary diversion requires diligent attention to hygiene and emptying collected urine. Though the neobladder is the most natural urinary diversion method, it requires more frequent emptying than would the natural bladder. Likewise the catheter reservoir, which further requires the person to carry a catheter at all times. URINARY TRACT INFECTION (UTI) tend to be more frequent in people who have any form of urinary diversion, though are most common with urostomy. Urostomy also may cause irritation to the SKIN around the stoma. Many people who have urostomies or catheter reservoirs feel self-conscious about them. The urologist or hospital can provide information about support groups where people who have urinary diversions can share their concerns and experiences.
See also COLOSTOMY; ILEOANAL RESERVOIR; ILEOSTOMY; QUALITY OF LIFE; SURGERY BENEFIT AND RISK ASSESSMENT.
Resource: Facts On File Encyclopedia Of Health And Medicine
At birth the structures of the urinary system are fully developed and function under the automatic control of the NERVOUS SYSTEM. The newborn’s KIDNEYS filter BLOOD and make URINE. The BLADDER collects the urine and, when it fills to a point that triggers the micturition REFLEX, it empties to drain urine via the URETHRA to outside the body. Voluntary
Excessive excretion of ALBUMIN, a form of protein, into the URINE. Albuminuria, also called proteinuria, typically indicates kidney conditions that affect the glomeruli (the tubular structures within the KIDNEYS that filter wastes and excess water from the BLOOD to excrete in the urine). Such conditions include GLOMERULONEPHRITIS, GLOMERULOSCLEROSIS,
What is Alport’s Syndrome An inherited genetic disorder in which one, two, or three mutations occur in the GENE that encodes type IV collagen formations, also called basement membranes. The mutations affect up to three of the six protein chains (alpha-3, alpha-4, and alpha-5) that make up type IV collagen, which is a foundation for a number of
What is Anuria and Definition Anuria - The failure to produce URINE. Numerous circumstances can result in anuria, from severe DEHYDRATION and severe HYPOTENSION (low BLOOD PRESSURE) to END-STAGE RENAL DISEASE (ESRD) and RENAL FAILURE. Anuria requires prompt medical evaluation to determine and remedy the underlying cause. Without such correction, waste
What is Bladder and Definition A muscular, saclike structure in the lower pelvis that serves as a reservoir for the URINE the KIDNEYS produce. In women the bladder is in front of and slightly below the UTERUS. During PREGNANCY the expanding uterus limits the bladder’s ability to expand, accounting for the URINARY FREQUENCY common in pregnancy’s
What is Uremia and Definition Uremia is a serious condition in which nitrogenbased toxins such as urea and creatinine, the primary waste products of METABOLISM, accumulate in the BLOOD because the KIDNEYS are unable to filter them out and pass them from the body via the URINE. Uremia indicates RENAL FAILURE. Urologists sometimes use the term azotemia to
Ureter, in a human organism, is a muscular tube, fairly thick and rigid, that leads URINE from the kidney to the urinary BLADDER. Both of the two tubular structures arise from the renal pelvis and collect the urine from the kidney’s collecting tubules. Both ureters with the inner diameter of 3 or 4 millimeters exit the kidney at the hilus. Then, the
A narrow, somewhat muscular tube that carries URINE from the BLADDER to the outside of the body. The point of exit is the urinary or urethral meatus. The urethral sphincter MUSCLE at the base of the bladder controls the release of urine into the urethra. Once the urethral sphincter relaxes to let urine pass, the urine flows to the outside of the body until
What is Urethral Stricture Narrowing of the URETHRA, impeding the passage of URINE from the BLADDER to the outside of the body. Urethral stricture may be congenital (present at birth) or acquired such as through scarring resulting from repeated URETHRITIS, BLADDER CATHETERIZATION, and other irritations to the urethra. BENIGN PROSTATIC HYPERPLASIA (BPH) and
What is Urethritis and Definition INFLAMMATION of an URETER. INFECTION, typically a sexually transmitted disease (STD), is the most common cause of urethritis though urethritis may occur as a result of inflammation or irritation from trauma such as occurs with BLADDER CATHETERIZATION or CYSTOSCOPY. Traumatic urethritis improves rapidly when the source of