Urinary Diversion

Indications

Urinary diversion is a beacon of hope for those battling bladder cancer, offering a solution when the entire bladder may need to be removed (cystectomy).

In addition, reasons urinary diversion is strongly advised:

• Damage to the nerves of the bladder due to congenital abnormalities such as spina bifida, injury to the spinal cord and multiple sclerosis.
• Persistent bladder inflammation may lead to chronic urinary tract infections, urinary retention and interstitial cystitis.
• Persistent urinary retention due to benign prostatic hyperplasia/enlarged prostate.
• Radiation therapy that results in irreversible damage to the bladder.
• Serious urinary incontinence cannot be adequately treated with standard treatment modalities.
• Severe trauma to urinary structures such as the pelvis, urethra and bladder.
• The formation of urinary stones
• Genitourinary tract tumours

Procedure

The primary forms of urinary diversion consist of the following:

• Bladder catheterisation: A surgical procedure that refers to the insertion of a narrow, bendable scope (catheter) within the bladder with the purpose of draining urine. The urine then effectively drains into an external bag on the outside of the body.
• Cystostomy: This entails placing a tiny tube inside the bladder through the lower abdominal skin. As a result, urine travels smoothly via the bladder to an external bag.
• Nephrostomy: Via a small incision, a tiny tube (nephrostomy tube) is inserted within the bladder through the skin over the back area in the kidney. This tube enables urine to run from the kidney to an external bag.
• Ureteral stent: A bendable, narrow tube is placed through the ureter to help urine run more smoothly from the kidney to the bladder. An instrument called a cystoscope is used to help guide the ureteral stent.
• Urostomy (stoma): This involves creating an opening inside the abdomen that attaches to the urinary tract for urine to pass through more easily.