Living with Urinary Diversion

In patients with invasive bladder cancer, the cancer cells have grown in the wall of the bladder muscle and/or the tumors are located in different areas of the bladder.¹ Patients with invasive bladder cancer may need to have a type of surgical treatment called a radical cystectomy. During a radical cystectomy, the surgeon removes that patient’s entire bladder. In male patients with advanced bladder cancer, the surgeon may also need to remove the prostate gland, the seminal vesicles, parts of the ureters, and lymph nodes in the pelvis. In female patients, the surgeon may also need to remove the uterus, ovaries, fallopian tubes, cervix, and part of the vagina.

What is a urinary diversion?

After the patient has a radical cystectomy, the surgeon typically creates a new way for the patient’s body to store and remove urine produced by the kidneys. This procedure is called a urinary diversion. There are currently three different ways that the surgeon can perform a urinary diversion, including:

• Creating an ileal conduit, which is also called incontinent diversion
• Creating an Indiana pouch reservoir, which is also called a continent diversion
• Creating a neobladder

Each of the types of urinary diversion has its own benefits and drawbacks. Patients discuss each of the options in detail with their cancer care team in order to choose the option that is best suited for their health and lifestyle.

Adjusting to life with a urinary diversion

Adjusting to life with a urinary diversion takes time, but many patients find that that they are able to adapt well and can do almost everything that they were able to do before the surgery. There are many resources available to help patients make a decision about which type of urinary diversion to receive, as well as supporting them during the recovery and adjustment period. For example, the Bladder Cancer Advocacy Network provides webinars on its website that can be a valuable resource as patients adjust.

What is an ileal conduit?

To create an ileal conduit, the surgeon uses a small piece of the patient’s intestine to create a connection between the patient’s ureters (the tubes that carry urine out of the kidneys) and a small opening in the patient’s abdomen, which is called a stoma or urostomy.² An external bag is placed over the stoma, where urine collects in a small continuous stream. Patients living with an ileal conduit learn how to empty the bag on a regular basis, as well as learn how to make sure that the seal between the bag and the stoma does not become loose or develop a leak.

What is an Indiana pouch?

In an Indiana pouch reservoir, or continent diversion, the surgeon also uses a small piece of the patient’s intestine.³ But unlike an ileal conduit, in which urine is stored in a pouch outside of the body, an Indiana pouch reservoir is created inside of the body. The pouch is connected to the patient’s ureters on one end and to a small opening in the patient’s abdomen (called a stoma) on the other end. Patients with this type of urinary diversion use a thin tube called a catheter to drain urine out of the internal pouch on a regular basis.

What is a neobladder?

A neobladder is another type of urinary diversion in which patients store urine inside the body.⁴ The surgeon uses a small piece of the patient’s intestine to create a pouch that is connected on one end to the patient’s ureters and on the other end to the patient’s urethra. The urethra is a tube-like organ that normally connects to the bladder and allows urine to flow out of the body. Urine collects in the neobladder and flows out of the body through the urethra. This allows the patient to urinate in a way that is more similar to normal urination than the other two types of urinary diversion. However, this type of urinary diversion can take a bit longer for patients to adjust to, because they must learn how to control the flow of urine out of the neobladder using their abdominal muscles.