The ileal conduit is a common and reliable type of urinary diversion surgery performed when the bladder is removed or can no longer function correctly. This procedure creates a new pathway for urine to exit the body, bypassing the damaged or removed bladder. It involves using a small segment of the patient’s small intestine to construct a channel for continuous urine flow. It is often considered the standard, most straightforward option for permanent urinary diversion.
Reasons for Urinary Diversion
The primary reason for needing a urinary diversion like an ileal conduit is the surgical removal of the bladder, a procedure called a cystectomy. This removal is most frequently performed to treat muscle-invasive bladder cancer. The procedure may also be necessary for other pelvic malignancies, such as prostate or endometrial cancer, that have spread to or severely impact the bladder.
Beyond cancer, severe damage or chronic disease of the urinary tract can necessitate this surgery. Conditions like chronic inflammation resulting from severe interstitial cystitis, recurrent urinary tract infections, or chronic urinary retention may lead to irreversible bladder damage. Severe congenital defects or trauma that permanently compromises bladder function also require a diversion to maintain kidney health.
Creating the Ileal Conduit
The ileal conduit procedure involves isolating a segment of the ileum, the lowest part of the small intestine, typically measuring about six to eight inches long. The surgeon removes this section while preserving its blood supply. The remaining ends of the small intestine are reconnected to maintain normal digestive function. This isolated segment of bowel is then transformed into the urine conduit.
The two ureters, which normally transport urine from the kidneys to the bladder, are detached and surgically connected to one end of the isolated ileal segment. This connection, often performed using a technique like the Bricker method, allows urine to flow directly into the intestinal tube. The other end of the ileum is brought out through a small opening created in the abdominal wall, usually on the right side below the navel.
This external opening is called a stoma, which is a soft, moist, pinkish-red bud of tissue that serves as the new exit point for urine. Because the stoma is formed from intestinal tissue, it continues to produce mucus, which is a normal feature of the draining urine. The ileal conduit itself does not store urine; it acts purely as a channel, allowing urine to flow continuously from the kidneys, through the conduit, and out of the stoma.
Daily Life and Management
Living with an ileal conduit requires the continuous use of an external collection appliance, often called a urostomy pouch, which adheres to the skin over the stoma. This pouch catches the urine that flows out constantly, as there is no muscular control over the stoma opening. The appliance consists of an adhesive skin barrier, or wafer, that sticks to the skin around the stoma, and a detachable bag that collects the urine.
The urostomy pouch needs to be drained several times a day when it becomes one-third to one-half full, using a twist valve at the bottom. The entire appliance is typically changed every three to seven days, depending on the system used and the condition of the skin. Consistent stoma care is necessary to prevent skin irritation, which occurs if the adhesive barrier does not fit correctly or if urine leaks onto the surrounding skin.
The skin around the stoma should be washed with warm water and gently patted dry during appliance changes, without the need for soap. Odor management is maintained by ensuring the pouching system is sealed properly and by draining the appliance regularly. Patients are taught to measure their stoma, as its size shrinks in the first six to eight weeks after surgery, requiring adjustments in the size of the appliance opening.
The guidance of a specialized ostomy nurse is instrumental in the training and ongoing support for patients. This nurse teaches the correct application of the pouching system, proper skin care techniques, and how to manage potential issues. With proper care and routine, most individuals can return to their normal daily activities, including work and physical activity, without significant limitation.
How the Ileal Conduit Differs from Other Methods
The ileal conduit is categorized as an incontinent urinary diversion because it allows urine to flow continuously and requires an external pouch for collection. This contrasts with continent urinary diversion methods, which are designed to allow a patient to control when urine leaves the body. These continent options involve creating an internal reservoir from a segment of the bowel to store the urine.
Continent Diversion Methods
One such method is the neobladder, which connects the internal pouch to the urethra, allowing the patient to urinate through the natural channel. Another is the continent cutaneous reservoir, such as the Indiana Pouch, which stores urine internally but requires the patient to insert a catheter through a small stoma on the abdomen several times a day to empty the reservoir. While continent diversions offer the benefit of not wearing an external pouch, the ileal conduit is a simpler surgical procedure with a lower overall rate of complications and a faster recovery time.