Urinary Diversion | Adult Pediatric Urology & Urogynecology Omaha

Urinary Diversion

Urinary diversion is a surgical procedure that reroutes the normal flow of urine out of the body when urine flow is blocked.

Urine flow may be blocked because of

  • an enlarged prostate
  • injury to the urethra
  • birth defects of the urinary tract
  • kidney, ureter, or bladder stones
  • tumors of the genitourinary tract–– which includes the urinary tract and reproductive organs––or adjacent tissues and organs
  • conditions causing external pressure to the urethra or one or both ureters

Bladder removal or a malfunctioning bladder may also cause blocked urine flow. When urine cannot flow out of the body, it can accumulate in the bladder, ureters, and kidneys. As a result, body wastes and extra water do not empty from the body, potentially resulting in pain, urinary tract infections, kidney failure, or, if left untreated, death. Urinary diversion can be temporary or permanent, depending on the reason for the procedure.

What is the urinary tract and how does it work?

The urinary tract is the body’s drainage system for removing urine, which is composed of wastes and extra fluid. In order for normal urination to occur, all body parts in the urinary tract need to work together in the correct order.

Kidneys

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine. The kidneys work around the clock; a person does not control what they do.

Ureters

Ureters are the thin tubes of muscle—one on each side of the bladder— that carry urine from each of the kidneys to the bladder.

Bladder

The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. Although a person does not control kidney function, a person does control when the bladder empties. Bladder emptying is known as urination. The bladder stores urine until the person finds an appropriate time and place to urinate.   A normal bladder acts like a reservoir and can hold 1.5 to 2 cups of urine. How often a person needs to urinate depends on how quickly the kidneys produce the urine that fills the bladder.

The muscles of the bladder wall remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to the brain tell a person to find a toilet soon.

What special care is needed after urinary diversion surgery?

After urinary diversion surgery, a wound, ostomy, and continence (WOC) nurse or an enterostomal therapist helps patients learn how to take care of their permanent urinary diversions. WOC nurses and enterostomal therapists specialize in ostomy care and rehabilitation. Patients should ask how to care for their stomas and pouches.

Caring for a Continent Stoma

A continent stoma requires daily care. Care focuses on maintaining a clean and healthy stoma by

  • wiping away extra mucus
  • washing the stoma and surrounding skin with mild soap and water
  • rinsing the stoma thoroughly
  • drying the stoma completely

Caring for a Noncontinent Stoma

A noncontinent stoma also requires basic daily care. Care focuses on maintaining a suitable and healthy skin area for attachment of the pouch by

  • wiping away extra mucus
  • washing the stoma and surrounding skin with mild soap and water
  •  rinsing the stoma thoroughly
  • drying the stoma completely

Patients should inspect their stoma and skin and notify their health care providers
of any changes, specifically evidence of skin breakdown, typically in an area where urine leaks between the pouch and stoma.

Caring for a Continent Cutaneous Reservoir

For a continent cutaneous reservoir, patients learn how to insert a catheter through the stoma or urethra to drain the internal reservoir. Patients can drain the reservoir by inserting the catheter while standing in front of the toilet or sitting on the toilet. During the first few weeks after urinary diversion surgery, patients need to drain the internal reservoir every couple of hours. Over time, the reservoir capacity will increase and patients will be able to go 4 to 6 hours between reservoir drainings. Patients should wash their hands with soap and water each time they use a catheter.

Before and after catheterization, patients should clean the stoma and skin around it with a wet towelette or washcloth and completely dry the stoma and skin.

The reservoir is made from part of the bowel, so it may produce mucus that normally lines the digestive tract. To clear this mucus, patients may need to irrigate, or flush out, the reservoir using a syringe with sterile water or normal saline. Patients should talk with a WOC nurse, an enterostomal therapist, or a urologist––a doctor who specializes in the urinary tract–– about how often they should irrigate the reservoir.

Caring for a Pouch

A person with an ileal conduit or with cutaneous ureterostomy also works with WOC nurses or enterostomal therapists to learn how to care for an external pouch.

The pouch system usually consists of two pieces—a barrier that sticks to the skin, known as a wafer, and a disposable plastic bag or pouch that attaches to the barrier. Sometimes the barrier and pouch are one unit. The barrier protects the skin from urine and is designed to be as gentle as possible on the skin. The length of time the barrier stays sealed to the skin depends on many things, such as whether the barrier fits properly, the condition of the skin around the stoma, the patient’s physical activity level, and the shape of the body around the stoma.

The pouch has a drain valve at the bottom so the patient can empty it into a toilet without removing the pouch from the stoma. During the day, most patients need to empty the pouch about as often as they used the bathroom before having urinary diversion surgery. Patients should empty the pouch when it is about one-third to one-half full. At night, patients can attach a piece of flexible tubing to the drain valve on the pouch to let urine flow into a bigger pouch during sleep.

Patients should rinse and clean the pouch daily and change it every 5 to 7 days. When changing a pouch, patients need to clean the skin around the stoma with a wet towelette or washcloth. The skin should be completely dry before applying a new pouch.

Activities

To help the stoma heal, patients need to restrict their activities, including driving and heavy lifting, during the first 2 to 3 weeks after urinary diversion surgery. Once the stoma has healed, patients should be able

to do most of the activities they enjoyed before urinary diversion surgery, even swimming and other water sports. The only exceptions may be contact sports such as football or karate. Patients whose jobs include strenuous physical activities should talk with their health care providers and employers about making adjustments to their job responsibilities.

Eating, Diet, and Nutrition

After urinary diversion surgery, patients will likely be able to resume their normal diet. Some foods, such as asparagus and seafood, may cause urine to have a stronger odor, which may be noticeable when emptying a pouch. If the odor is a concern, patients should talk with their health care providers about changes in diet. Patients should also talk with their health care providers about their dietary needs. Some patients with continent urinary reservoirs have a chance of vitamin B deficiency and may require lifelong vitamin B injections.

This requirement is only for a specific type of diversion and should be discussed with the health care provider in detail.

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