Urinary Diversion

Abstract

Urinary diversion is a surgical procedure which re-routes urine from its normal pathway and is necessary where the lower urinary tract has to be removed or is severely dysfunctional. The goals are to improve quality of life, preserve renal function by providing a low-pressure reservoir, allow control of voiding, minimise urinary tract infections and avoid immediate or late postoperative complications. Diversion usually employs reconfigured bowel segments isolated from the gastrointestinal tract and placed in continuity with the urinary tract. Preoperative assessment requires identification of contraindications, such as impaired renal or hepatic function and bowel dysfunction. The patient needs to be prepared for the psychological and physical impact if a stoma is needed, and the best location for a stoma needs to be identified by a trained specialist. Diversions may be incontinent (continuous flow of urine to the external environment), of which an ileal conduit is most commonly used. Continent diversions offer storage in a reservoir, which often need to be drained intermittently with a catheter, and various approaches to continent diversion have been described. Complications can be serious, including per-operative morbidity, infections, renal and metabolic problems, bowel dysfunction, and stoma problems.