Bladder Cancer
Reconstruction
When treatment includes surgically removing your bladder (radical cystectomy), it is followed by a reconstructive operation that diverts, or finds another path, for urine to leave your body. There are three primary options for urinary diversion.
Ileal conduit
An ileal conduit involves the creation of a new passageway for urine using a piece of the small intestine, called the ileum. The ureters are attached to the end of the surgically isolated intestine. The other end of the ileum is attached to the skin through an incision in the abdominal wall. This creates a stoma, an opening through the abdominal wall.
Urine flows continuously through the new passageway to an external ostomy bag that is emptied periodically. The pouch lies flat against the body and can be covered with clothes. This is called incontinent diversion because you do not control the flow of urine from your body.
Continent urinary diversion
Continent urinary diversion allows you to control when urine leaves your body. Urine is collected and stored in a pouch inside the body until you drain it using a catheter or you urinate through the urethra.
A continent cutaneous pouch (or Indiana pouch) involves an internal storage container for urine made from a section of intestine attached to the ureters. The pouch is folded and then connected to a stoma on one end with the ureters on the other. It is drained by inserting a small, string-like tube called a catheter through the stoma.
Orthotopic bladder (neobladder)
An orthotopic bladder, or neobladder, uses a small portion of your intestine to act as an internal reservoir for storing urine. One end is attached to the ureters, while the other is attached to the urethra. Urine is able to leave your body in the regular way. During the healing process, urine is drained through a
catheter or stents (small mesh tubes), which are placed into the neobladder through a small incision in the abdomen. At first, you will not have control over urine flow. You may, however, over time.
Bladder Removal and Reconstruction
5 Tips About a Stoma
Your ostomy nurse will be a valuable resource as you get comfortable with your stoma.
- Before the surgery, talk with the ostomy nurse about where to place the stoma. Placement affects your clothing options, such as where your belt or waistband sits.
- Lower your risk of infection by washing your hands with soap and water before and after caring for your stoma and pouch. Keep the area around your stoma clean by using water and patting dry.
- Change the pouch regularly to help avoid leaks and skin irritation.
- Shave the area around the pouch to help the pouch stick better to skin.
- Pouches include filters that help prevent odors. Fragrance drops or sprays can further mask odor.
