Urinary Diversions

Urinary Diversions

Urinary diversion procedures are performed to divert urine from the bladder to a new exit site, usually through a surgically created opening (stoma) in the skin. These procedures are primarily per-formed when a bladder tumor necessitates removal of the entire bladder (cystectomy). Urinary diversion has also been used in managing pelvic malignancy, birth defects, strictures, trauma to ureters and urethra, neurogenic bladder, chronic infection caus-ing severe ureteral and renal damage, and intractable interstitial cystitis and as a last resort in managing incontinence.

Controversy exists about the best method of establishing per-manent diversion of the urinary tract. New techniques are fre-quently introduced in an effort to improve patient outcomes and quality of life. The age of the patient, condition of the bladder, body build, degree of obesity, degree of ureteral dilation, status of renal function, and the patient’s learning ability and willingness to participate in postoperative care are all taken into consideration when determining the appropriate surgical procedure. Creating a reliable continence mechanism for a continent reservoir is a great challenge. The ability of urinary diversions to be continent devices for both ease of emptying and better quality of life has been the focus of research during recent years (Abol-Enein & Ghoneim, 2001; Deliveliotis, Alargoff, Skolarikos et al., 2001; Kane, 2000; Yachia & Erlich, 2001; Zinman, 1999).

The extent to which the patient accepts urinary diversion de-pends to a large degree on the location or position of the stoma, whether the drainage device (pouch or bag) establishes a water-tight seal to the skin, and the patient’s ability to manage the pouch and drainage apparatus. Paying attention to these consid-erations helps to promote a positive outcome (Kane, 2000).

There are two categories of urinary diversion: cutaneous uri-nary diversion, in which urine drains through an opening created in the abdominal wall and skin (Fig. 45-9), and continent uri-nary diversion, in which a portion of the intestine is used to cre-ate a new reservoir for urine (Fig. 45-10).