The urinary system includes the kidneys, ureters, bladder, and urethra. Together, these organs produce, transport, store, and eliminate urine from the body.

When the normal pathway for urine is damaged, blocked, or removed, a urinary diversion may be required. Urinary diversion is a surgical procedure that creates a new route for urine to leave the body or be stored before elimination.

A urinary diversion may be considered in certain situations, including bladder removal, severe urinary tract damage, some cancers and conditions that significantly affect the normal passage or storage of urine.

What Can Affect the Normal Function of the Urinary Tract?

Several conditions can interfere with normal urine flow or bladder function, including:

• Bladder cancer requiring removal of the bladder
• Certain advanced or complicated urinary tract conditions
• Severe bladder dysfunction
• Urinary tract obstruction
• Urethral stricture
• Significant urinary tract injury
• Certain congenital urinary tract abnormalities
• Neurological conditions affecting bladder function

Importantly, not every bladder or urinary problem requires urinary diversion. The appropriate treatment depends on the underlying condition and the patient’s overall health.

What Are the Main Parts of the Urinary Tract?

Kidneys

The kidneys filter waste products and excess fluid from the blood to produce urine. The urine then passes from the kidneys into the ureters.

Ureters

The ureters are narrow muscular tubes that carry urine from each kidney to the bladder.

Bladder

The bladder is a muscular organ that stores urine until it is released during urination.

Urethra

The urethra carries urine from the bladder to the outside of the body.

When part of this system cannot perform its normal function, treatment may sometimes involve creating an alternative pathway for urine.

What Are the Types of Urinary Diversion?

The type of urinary diversion depends on the underlying condition, the organs involved, previous treatments, and the patient’s overall health.

1. Cutaneous Ureterostomy

In a cutaneous ureterostomy, one or both ureters are brought directly to the skin to create a stoma through which urine drains.

This approach may be considered in selected patients, particularly when a simpler diversion is appropriate or when using the bowel is not suitable.

2. Ileal Conduit

An ileal conduit is one of the most commonly performed forms of incontinent urinary diversion.

A short segment of the small intestine is used to create a conduit. The ureters are connected to this segment, which is then brought through the abdominal wall to create a stoma.

Urine continuously drains through the stoma into an external collection bag.

An ileal conduit may be considered when a patient requires urinary diversion but does not need or is not suitable for a continent diversion.

3. Continent Cutaneous Urinary Diversion

A continent urinary diversion uses a segment of bowel to create an internal reservoir for urine. Instead of continuously draining into an external bag, the patient empties the reservoir periodically using a catheter through a small stoma.

One example is a continent catheterizable pouch.

This option requires the patient to be able and willing to perform intermittent self-catheterization.

4. Mitrofanoff Procedure

The Mitrofanoff procedure creates a catheterizable channel between the bladder or a urinary reservoir and the skin.

The channel is usually created using the appendix or another suitable tissue.

The patient can pass a catheter through the small opening to empty the bladder or reservoir.

5. Orthotopic Neobladder

An orthotopic neobladder is a type of urinary reconstruction in which a segment of intestine is used to create a new urine reservoir.

The reservoir is connected to the urethra, allowing the patient to pass urine through the natural urinary pathway.

Not every patient is a suitable candidate for a neobladder. Factors such as the location of disease, urethral function, kidney function, overall health and the ability to manage the reconstructed bladder are considered before surgery.

6. Bladder Augmentation

Bladder augmentation, also called augmentation cystoplasty, increases the storage capacity of the bladder by adding a segment of intestine or other tissue to the bladder.

It may be considered in selected patients with severe bladder storage problems when other treatments have not been effective.

Patients may need long-term follow-up after this procedure because complications can occur, including urinary retention, infections and metabolic changes.

Is Urethroplasty a Urinary Diversion Procedure?

Urethroplasty should not generally be classified as a urinary diversion procedure.

Urethroplasty is a reconstructive surgery used primarily to repair a narrowed or scarred urethra, commonly known as a urethral stricture.

The goal is to restore the normal passage of urine through the urethra rather than create an alternative route for urine.

This distinction is important when explaining urinary diversion procedures to patients.

When Is Urinary Diversion Needed?

Urinary diversion may be considered when the normal urinary pathway cannot safely or effectively perform its function.

Some situations where urinary diversion may be considered include:

• Removal of the bladder for bladder cancer
• Severe bladder dysfunction
• Certain urinary tract injuries
• Complex urinary tract abnormalities
• Selected cases of neurogenic bladder
• Certain congenital urinary tract conditions

The decision is individualized and requires a detailed evaluation by a urologist.

How Does a Urologist Choose the Right Urinary Diversion?

There is no single urinary diversion procedure that is appropriate for everyone.

A urologist may consider:

• The underlying disease
• Whether the bladder needs to be removed
• Kidney and ureter function
• Urethral condition
• Previous abdominal or pelvic surgery
• Overall health
• Ability to perform self-catheterization
• Lifestyle and personal preferences
• Expected long-term follow-up requirements

The doctor may use imaging, blood tests, urine tests, and other evaluations before recommending a particular procedure.

Conclusion

Urinary diversion procedures provide an alternative pathway for urine when the normal urinary system cannot function effectively or when the bladder has been removed.

Common options include ileal conduit, cutaneous ureterostomy, continent urinary diversion, Mitrofanoff procedures, and orthotopic neobladder reconstruction. Each procedure has different requirements, advantages and potential complications.

If you have been advised to undergo urinary diversion or are experiencing significant problems with urine flow or bladder function, a detailed evaluation by a qualified urologist is important.

You can learn more about Dr. Dushyant Pawar and his urological services or contact the clinic to discuss your condition and available treatment options.