If your bladder is removed during a radical cystectomy, an alternative way of passing urine out of your kidneys will need to be found. There are a number of different treatment options, which are described below. In some cases, you may be able to make a choice based on your personal preferences.
A urostomy is the most common type of urinary diversion operation. During the operation, the surgeon will make a hole in your abdominal wall. This hole is known as a stoma. A small section of your small bowel will be removed and connected to your ureters (the two tubes which, in normal circumstances, carry urine out of the kidneys). The other end of the small bowel will be connected to your stoma. A flat, water-proof pouch is then connected to the stoma to collect the urine.
Continent urinary diversion
A continent urinary diversion is a similar sort of operation to an urostomy, except that you will not be required to use a pouch. A section of your bowel will be used to create an internal pouch that is used to store your urine. The pouch will then be connected to your ureters at one end, and to a stoma that is made in your abdominal wall at the other end. You can empty the pouch by inserting a catheter (a thin, flexible tube) into the stoma and use it to drain away the urine. Most people need to empty their pouch about four to five times a day.
In some cases, it may be possible to create a “new bladder”, known as a neobladder. This can be done by removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra at one end and your ureters at the other end. Due to the loss of normal nerve function, around 20%-30% of people with a neobladder will experience some episodes of incontinence (the involuntary passing of urine), which usually occur during the night when they are sleeping. It may be useful to empty your neobladder at set times each day, and then once more before you go to sleep, because this may help to prevent incontinence.
For further support please contact the Urostomy Association. They offer support, reassurance and practical information to anyone who may be about to undergo, or who has already had surgery resulting in a urostomy, continent urinary pouch or a neo-bladder. Appropriate support and advice is also offered to families and carers both before and after surgery.
Urostomy Association. Telephone helpline: 01889 563191