Renal complications following ureteral diversion
- Biff F Palmer, MD
Biff F Palmer, MD
- Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Michael Emmett, MD
Michael Emmett, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Chief of Internal Medicine
- Baylor University Medical Center
Urinary diversion is a surgical procedure in which the normal flow of urine out of the body is rerouted away from the bladder. This procedure is most commonly performed following cystectomy due to medically refractory invasive bladder cancer . Other indications for cystectomy include neurogenic bladder disease due to spinal cord lesions, urinary incontinence, vesicovaginal fistulae, scarring due to infection or chemotherapy, and failed reconstruction after congenital anomalies .
There are three major forms of urinary diversion performed in patients requiring a cystectomy (see "Urinary diversion and reconstruction following cystectomy" and "Radical cystectomy and bladder-sparing treatments for urothelial bladder cancer" and "Laparoscopic/robotic-assisted radical cystectomy"):
●Ileal conduit – A non-continent cutaneous diversion in which the urine flows from the ureters through a segment of bowel (usually ileum, termed ileal conduit) to the skin surface as a stoma, where it is collected in an external bag or other appliance.
●Continent cutaneous diversion – A cutaneous continent reservoir may be constructed to avoid the need for an external appliance (usually using the right colon and terminal ileum). The patient self-catheterizes him- or herself at regular intervals to empty the reservoir.
●Orthotopic neobladder – For men and women wishing to avoid cutaneous urinary diversion, an orthotopic neobladder may be formed from a segment of bowel and attached to the urethra, enabling them to void through the urethra. Continent diversions can greatly improve patient quality of life and self-image and can increase his or her acceptance of radical cystectomy.
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