Urinary Diversion: What Is It, Types & Surgery Options (2023)


What is urinary reconstruction and diversion?

Urinary Diversion: What Is It, Types & Surgery Options (1)

When your urinary bladder is removed (due to cancer, other medical conditions or because the organ no longer works), you need another way to pass urine through your body (pee). Urinary reconstruction and diversion are types of surgery done to help you do this.

Urinary tract anatomy

The urinary tract normally consists of two kidneys, two ureters, a urinary bladder and a urethra:

  • The kidneys filter your blood and remove water and waste through the urine.
  • The urine travels from the kidney to the bladder through tubes called ureters.
  • The urine is stored in the urinary bladder, and then moves through the urethra to be passed out of the body when you urinate.

When the bladder is removed, urine needs to exit the body in a new way, through a urinary diversion. In all of the types of urinary diversions, a part of the intestine is surgically converted to either 1) a passage tube for urine to exit the body, or 2) a reservoir to store urine (like a normal bladder).

Regardless of surgical method, urine and stool remain completely separate from each other. (They are two different systems — the urinary and digestive systems — respectively.)

What are the urinary diversion options?

There are three main types of urinary diversion surgeries:

  • Ileal conduit urinary diversion.
  • Indiana pouch reservoir.
  • Neobladder-to-urethra diversion.

For all of these procedures, a portion of the small and/or large bowel is disconnected from the fecal stream and used for reconstruction.

(Video) Bladder Cancer Treatment: Urinary Diversion - Urology Care Foundation

Ileal conduit urinary diversion

Urinary Diversion: What Is It, Types & Surgery Options (2)

Ileal conduit urinary diversion: A segment of the intestine directs urine through a stoma into an external collecting bag.

With this procedure, the ureters (the tubes that carry urine from the kidneys to the bladder) drain freely into part of the ileum (the last segment of the small intestine). The end of the ileum into which the ureters drain is then brought out through an opening in the abdominal wall. This opening, called a stoma, is covered with a bag that gathers the urine as it drains from the ileal conduit.

Advantages and disadvantages

The advantages of the ileal conduit urinary diversion surgery are:

  • It is a relatively simple surgery.
  • It requires less surgical time (compared with other surgical methods).
  • There is no need for occasional catheterization (use of a tube to drain the urine)

The disadvantages of the ileal conduit urinary diversion are:

  • There’s a change in body image.
  • It uses an external bag to collect urine, which might leak or have odors.
Indiana pouch reservoir

Urinary Diversion: What Is It, Types & Surgery Options (3)

(Video) Urinary Diversions

Indiana pouch reservoir: A pouch is made out of portions of intestines stores urine until it is drained via a catheter inserted through the stoma.

With this type of surgery, a reservoir or pouch is made out of a portion of the large intestine (the ascending colon on the right side of the abdomen) and a portion of the ileum (the last segment of the small intestine). The ureters are repositioned to drain into this pouch. The urine flows freely in a downward direction from the kidneys into the pouch. This positioning prevents urine from backing up into the kidneys, which protects the kidneys from infection. A short piece of small intestine is then brought out through a small opening in the abdominal wall (a stoma). The stoma is very small and can be covered with an adhesive bandage.

Unlike the ileal conduit, no external bag is needed. Instead, a one-way valve is surgically created to keep the urine inside the pouch. Several times a day (usually every four hours around the clock), a small, thin catheter must be passed through the stoma and into the pouch to empty the urine. An adhesive bandage is worn over the stoma at all other times (when not actively emptying the pouch).

Most insurance policies will allow you to have enough catheters so that you can use a new one each time. If your policy doesn’t, or if you run out, catheters can be washed with soap and water and reused. The catheters don’t have to be sterilized. They can be taken on trips or social events and simply stored in a plastic bag.

Advantages and disadvantages

The advantages of the Indiana pouch reservoir surgery are:

  • Urine is kept inside the body, in the reservoir, until it’s ready to be emptied.
  • No external bag is necessary.
  • There is no odor.
  • The risk of urine leaking is minimal.
  • The small stoma can be covered with an adhesive bandage.

The disadvantages of the Indiana pouch are:

(Video) Urinary Diversion Surgery

  • The surgery takes longer compared with the ileal conduit.
  • There is the need for occasional catheterization (the passing of tubing into the stoma to empty the pouch), every four hours around the clock.
Neobladder-to-urethra diversion

Urinary Diversion: What Is It, Types & Surgery Options (4)

Neobladder-to-urethra diversion: Intestine is made into a reservoir and connected to the urethra.

This procedure most closely resembles the storage function of a urinary bladder. A small part of the small intestine is made into a reservoir or pouch, which is connected to the urethra. The ureters are repositioned to drain into this pouch.

Urine is able to pass from the kidneys, to the ureters, to the pouch, and through the urethra in a manner similar to the normal passing of urine. To empty the pouch, you need to contract (tighten) your abdominal muscle.

To be a candidate for this surgery, there must be a low risk of cancer recurrence (return) in the urethra. Occasionally, people aren’t able to empty adequately by contracting their abdominal muscles. In these cases, they must pass a catheter into the urethra to empty the pouch, up to six times a day. If this isn’t something you’re willing or able to do, you probably shouldn’t consider this type of diversion.

Advantages and disadvantages

The advantages of the neobladder-to-urethra diversion are:

(Video) Urinary Diversion after radical cystectomy

  • The process of urination most closely matches normal urination.
  • No stoma is needed.

The disadvantages of the neobladder-to-urethra diversion are:

  • Surgery time is slightly longer than the ileal conduit urinary diversion procedure.
  • While regaining control of urination, urinary incontinence (leakage of urine) is normal after surgery, but might last up to six months. Also, about 20% of patients during the night and 5% to 10% of patients during the day are incontinent (leak urine) and have to wear a pad.
  • Despite the surgery, some patients might not be able to empty their bladder well and will need to perform occasional catheterization (passing tubing through the urethra into the pouch every four hours) for a prolonged period of time after surgery, and perhaps permanently.

Recovery and Outlook

What can I expect after urinary reconstruction and diversion?

After urinary reconstruction and diversion, it takes one to two months to feel well again and to regain your strength. Don't hesitate to call your doctor or other healthcare team members for assistance or if you have questions. Their goal for you is to get you back to your lifestyle as soon as possible.

What restrictions will I face after urinary reconstruction and diversion?

People with urinary diversions are usually able to return to the life, work and hobbies they previously enjoyed:

  • Work: Most people can return to their jobs in one or two months, on average. If you have concerns about your line of work or other job hazards, be sure to ask your doctor.
  • Activities: After the post-operative period, exercising and participation in sports and other activities is encouraged. Check with your doctor or healthcare team member.
  • Diet: There are no eating restrictions. If you have special dietary concerns, ask your doctor or health care team member.
  • Travel: There are no travel restrictions. You should travel fully prepared with necessary supplies, as you might not be able to purchase all supplies at your destination.

A note from Cleveland Clinic

As with any life change, an adjustment period is normal after a major surgery. It's not unusual to feel a little depressed or discouraged. Talk about your feelings with friends and family. If you join a support group, other members may be able help you deal with your emotions. (Ask your healthcare team member about support groups in your area.)


What is the most common type of urinary diversion? ›

A urostomy is the most common type of urinary diversion operation. During the operation, the surgeon will make a hole in your abdominal wall. This hole is known as a stoma.

What is meant by urinary diversion? ›

A surgical procedure to make a new way for urine to leave the body. It may involve redirecting urine into the colon, using catheters to drain the bladder, or making an opening in the abdomen and collecting urine in a bag outside the body.

How long does urinary diversion surgery take? ›

You will wear a urostomy pouching (bag) system (appliance) over your stoma to catch and hold the urine. This surgery usually takes about 3 to 6 hours. It may take longer if you have other medical conditions or have had past surgeries.

How many types of urinary catheters are there? ›

There are 3 main types of catheters: Indwelling catheter. Condom catheter. Intermittent self-catheter.

What is urostomy surgery? ›

A urostomy is an opening in the belly (abdominal wall) that's made during surgery. It re-directs urine away from a bladder that's diseased, has been injured, or isn't working as it should. The bladder is either bypassed or removed.

What are the complications of urinary diversion? ›

Deterioration of renal function after urinary diversion may be a consequence of complications related to the diversion including recurrent urinary tract infections (UTIs), obstructive uropathy, and factors impertinent to urinary diversion, such as age, medications, hypertension, and diabetes mellitus.

Why do people need urinary diversion? ›

A urinary diversion is done when the normal flow of urine is blocked or the bladder can't store urine. The most common reason to have a urinary diversion is after the whole bladder is removed for bladder cancer. A urinary diversion may also be called a urinary tract diversion or bladder diversion.

What can I expect after my urostomy surgery? ›

You will probably need pain medicine for 1 to 2 weeks. You can expect your urostomy (stoma) to be swollen and tender at first. This usually improves after 2 to 3 weeks. You may notice some blood in your urine or that your urine is light pink for the first 3 weeks after surgery.

How long can you live after bladder removal? ›

Patients in group 1 achieved a progression-free 5-year survival rate of 77% and an overall survival rate of 63% after 5 years. In group 2 patients achieved a progression-free survival rate of 51% after 5 years and an overall survival rate of 50%.

What is the most common urostomy procedure? ›

Type of urostomies

The most common method is called an ileal conduit. Here are the basics of this procedure: The surgeon removes a short segment of the small intestine (ileum). This will be used as a pipeline – or conduit – for urine to flow out of the body.

What can you not do after bladder surgery? ›

Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for about 3 weeks, or until your doctor says it is okay. For about 3 weeks, avoid lifting anything that would make you strain.

How long after bladder surgery can you drive? ›

After a rigid cystoscopy: rest at home for a day or two – you may need to take a couple of days off work. make sure someone stays with you for the first 24 hours. do not drive or drink alcohol for at least 24 hours.

What should I wear after bladder surgery? ›

After all surgery's for clothing I wear loose fitting, 100% cotton muu-muus or housedresses so nothing is binding and for you a dress would make cleaning of catheter easier.

What are the 4 types of catheters? ›

Types of Urinary Catheters
  • Foley catheter. This kind stays put. ...
  • Intermittent catheters. You use one of these several times a day, either at scheduled times or whenever your bladder feels full. ...
  • Suprapubic catheter. ...
  • Condom catheter.
Jul 1, 2020

What is a normal catheter size? ›

The average catheter size used by adult men is between 14FR to 16FR. Most men use 14FR catheters. The average catheter size used by adult women ranges from 10FR to 12FR.

What is a 2 way catheter? ›

The other lumen has a valve on the outside end and connects to a balloon at the tip; the balloon is inflated with sterile water when it lies inside the bladder, and allows for retention in the bladder. These are known as two-way catheters.

Is a urostomy major surgery? ›

Because this section of the intestine is too small to function as a reservoir, and there is no muscle or valve to control urination, you will need a urostomy pouch to collect the urine. Urostomy surgery is a major operation, so it is normal to feel weak for a while.

How long does a urostomy last? ›

The surgeon will attach the ureters to the tube leading to the stoma. The surgery could last as long as six hours.

How long does a urostomy bag last? ›

You may be using a 2-piece system, where the wafer and pouch are separate, or a 1-piece system, where the wafer and pouch are attached. You should change your pouching system every 3 to 4 days. It's best to change it in the morning before you eat or drink anything, when there's less urine (pee) coming from your stoma.

Which is better ileal conduit or neobladder? ›

Urinary function is worse in neobladder patients compared to ileal conduit patients. Sexual function is better in neobladder patients but causes much more bother. In retrospect, none of the patients regret their choice of urinary diversion.

What is Intracorporeal urinary diversion? ›

Transitioning from open to intracorporeal urinary diversion

Radical cystectomy (RC) with urinary diversion (UD) is the standard of care for muscle-invasive bladder cancer. The conventional open procedure to extirpate the bladder is associated with significant post-operative morbidity.

How long will a Neobladder last? ›

The Studer Orthotopic Neobladder: Long-Term (More Than 10 Years) Functional Outcomes, Urodynamic Features, and Complications.

Who is a candidate for a neobladder? ›

Neobladder. If a person is healthy enough for more complex surgery, a doctor may be able to create a new bladder, known as a neobladder. People who have a tumor that has not spread to the urethra and who are in good health may be candidates for this surgery.


1. Urinary Diversion Surgery - NMC Capsules
(NMC Healthcare)
2. Patient information about urinary diversion surgery
(Neurogenic Bladder Research Group (NBRG))
3. 5.26.2020 Urology COViD Didactics - Almost Everything You Wanted to Know About... Urinary Diversions
(Urology Residents)
4. Continent v incontinent urinary diversion techniques
5. Ureterocutaneostomy: A Valuable Option for Urinary Diversion in the Elderly Patient?
(Grand Rounds in Urology)
6. Urinary Diversion
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