Urinary diversions are ways of releasing urine from a patient’s body when they cannot urinate following a malfunction in the urinary system. The two general forms of diversions include incontinent and continent urinary diversions. The following is a further explanation as well as the advantages and disadvantages of each procedure.
Incontinent Urinary Diversion is an old form of tract reconstruction. Blake et al. (2010) present it as the quickest and simplest form of urinary diversions due to its familiarity across many urologists and other physicians. In this procedure, urologists harvest a section of the small intestine, attach a ureter to its proximal, and connect a portion of this intestinal portion to the abdominal wall as a stoma (Blake et al., 2010).
The advantages of incontinent urinary diversion include ease of development and simplicity. Also, patients are at an advantage following controlled toileting and almost perfect post-operative healing compared to other urinary diversions. Contrarily, patients will have to wear stoma appliances or bags on their abdominal walls as urine collection points. Also, it is only attractive to patients with major surgical co-morbidities and old individuals upon bladder removal (Blake et al., 2010).
Continent urinary diversions include cutaneous pouches and neobladders. According to Cody, et al. (2012), neobladders involve the creation of new bladders using a section of the intestine. Procedurally, physicians harvest 50-60 cm of the ileum and reconfigure it into a reservoir that holds implanted ureters. They then anastomose the dependent part of the new bladder to the remainder of the urethral stump. Cutaneous pouches come from a part of the ileum and large intestine. Here, urologists reposition ureters to drain into the resulting bag. Urine then flows freely from the kidneys into this pouch or reservoir (Cody, et al., 2012).
Veeratterapillay et al. (2013) suggest that the advantage of neobladders and cutaneous pouches is that they lack a stoma. However, there is a need for constant urination between 2 to 4 hours. There is also the possible inability of individuals to empty their neobladders completely. Lastly, both cases involve long and complicated surgical procedures compared to incontinent UD (Veeratterapillay et al., 2013).
References
Blake, E., James, M., & Scott, M. G. (2010). Incontinent or continent urinary diversion: how to make the right choice. Current Opinion in Urology, 20 (5), 421–425.
Cody, J., Nabi, G., Dublin, N., McClinton, S., Neal, D., Pickard, R., & Yong, S. M. (2012). Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy. The Cochrane Database of Systematic Reviews, 5, doi: 10.1002/14651858.CD003306.pub2.
Veeratterapillay, R., Morton, H., Thorpe, A., & Harding, C. (2013). Reconstructing the lower urinary tract: The Mitrofanoff principle. The Indian Journal of Urology, 29 (4), 316–321.
