An ileovesicostomy is a type of urinary diversion surgery designed to reroute the flow of urine. This operation uses a segment of the small intestine (the ileum) to create a channel from the bladder to an opening on the abdominal wall. The procedure creates a non-continent, free-flowing pathway for urine, which drains continuously into an external collection pouch. It is a specialized option reserved for patients whose bladder function is severely compromised and cannot be managed by less invasive methods.
Conditions Requiring the Procedure
This surgical option is often considered when a patient faces complex, long-standing issues that have severely impaired the lower urinary tract’s ability to store or empty urine safely. The most frequent indication for an ileovesicostomy is severe neurogenic bladder dysfunction, which occurs when nerve damage prevents the brain and bladder from communicating effectively. This dysfunction is commonly associated with conditions like spina bifida or spinal cord injury, particularly in patients who have high spinal lesions and may lack the dexterity to perform self-catheterization.
The procedure protects the upper urinary tract—the kidneys and ureters—from damage caused by high pressure within the bladder. When the bladder cannot empty properly or has poor compliance, urine can back up toward the kidneys, leading to hydronephrosis and recurrent urinary tract infections (UTIs). In these cases, the ileovesicostomy acts as a low-pressure “chimney” to continuously drain the bladder.
Other situations warranting this diversion include severe, intractable lower urinary tract obstruction that cannot be resolved through other means. Patients who have suffered extensive pelvic trauma or who have undergone radical pelvic surgery for cancer may also require this procedure if their bladder is severely damaged or functionally compromised. For many, this surgery is a viable alternative to lifelong, frequent intermittent catheterization, particularly if the patient has difficulty adhering to a strict schedule or experiences repeated complications from catheter use.
While an ileal conduit completely bypasses and removes the bladder, the ileovesicostomy preserves the native bladder by attaching the intestinal segment to the top of the existing organ. Preserving the bladder is sometimes preferred because it may allow for future reconstructive surgery if new medical advancements become available. This approach is chosen when less intrusive methods, such as long-term suprapubic catheters, have failed to provide adequate drainage or relief from symptoms.
Understanding the Surgical Technique
The ileovesicostomy is a major operation performed under general anesthesia, and it can be carried out through an open incision or a minimally invasive robotic or laparoscopic approach. The choice of technique often depends on the patient’s specific anatomy and the surgeon’s expertise. The primary goal is the creation of a new, well-vascularized channel to reroute urine flow without tension.
The procedure begins by isolating a segment of the ileum (the last part of the small intestine), typically 10 to 15 centimeters long. This segment must retain its blood supply (the mesentery) to ensure its viability as a urinary conduit. After isolation, the remaining small intestine is reattached to restore the continuity of the digestive tract.
The isolated ileal segment is then prepared to function as the drainage channel, often called an ileal chimney. One end of this intestinal tube is connected to the dome, or top, of the patient’s bladder through a watertight surgical connection known as an ileovesical anastomosis. This allows urine to flow directly into the newly created ileal segment.
The other end of the ileal segment is brought out through a small opening in the abdominal wall, usually in the lower right quadrant, to form the stoma. The surgeon sutures the edges of the intestinal segment to the skin to create a mature, pink stoma that provides a free-flowing exit for the urine. A temporary catheter is often placed through the stoma for several weeks following surgery to allow the internal connections to heal completely.
Post-Operative Management and Stoma Care
Immediate recovery involves close monitoring in the hospital, typically lasting between four and seven days, to manage pain and ensure the new urinary system is functioning correctly. During this initial phase, patients are encouraged to begin early mobilization, which helps reduce the risk of complications like blood clots and promotes the return of normal bowel function. A temporary drainage tube, or catheter, remains in place through the stoma to ensure the new channel heals without obstruction.
Long-term management centers entirely on caring for the urinary stoma and the external collection pouch, or appliance. The stoma, which is moist and red like the inside of the mouth, has no nerve endings, so its care is not painful. Patients must learn to apply a pouching system, which consists of a skin barrier (or wafer) that adheres to the skin and a collection pouch that locks onto the barrier.
Specialized training from a Wound, Ostomy, and Continence (WOC) nurse teaches the patient or caregiver how to properly fit, empty, and change the appliance. The goal is to ensure a secure, leak-proof seal to protect the peristomal skin (the skin surrounding the stoma) from constant exposure to urine. Improper fit or infrequent changes can lead to skin irritation and breakdown.
Patients and caregivers must also be aware of potential long-term complications associated with the stoma. These can include stomal stenosis, where the opening narrows over time, or the formation of a parastomal hernia, which occurs when abdominal contents push through the muscle wall near the stoma. Vigilance for signs of urinary tract infection remains important, as does annual follow-up, often including an ultrasound, to ensure the upper urinary tract remains healthy and effectively drained by the ileovesicostomy.