What is urinary diversion?
Urinary diversion is a major reconstructive surgery that creates a new way for urine to leave the body when the bladder has been removed (cystectomy) or can no longer function adequately. The most common reasons include bladder cancer requiring radical cystectomy, severe radiation damage, refractory bladder dysfunction, or complex fistula disease that cannot be repaired.
There is no single "best" diversion — the right choice depends on a patient's anatomy, cancer history, kidney function, dexterity, lifestyle, and personal goals. Dr. Wiegand has a detailed conversation with every patient about what each option actually means for daily life before any decision is made.
This is a major decision — take your time
Choosing a urinary diversion is not urgent in most cases. Patients are encouraged to ask questions, bring family members to appointments, and review resources like the Bladder Cancer Advocacy Network (BCAN), which has excellent videos and personal stories about life with each type of diversion. These resources are helpful even if you do not have cancer.
When is urinary diversion needed?
Urinary diversion is considered when the bladder must be removed or when it can no longer safely store or drain urine despite all other measures. Common reasons include:
-
Bladder Cancer (Radical Cystectomy)
The most common indication. When muscle-invasive or high-risk bladder cancer requires complete removal of the bladder, a diversion is created at the same time to restore urinary drainage.
-
Radiation Damage
Pelvic radiation for prostate, rectal, gynecologic, or bladder cancer can severely damage the bladder over time — causing hemorrhagic cystitis, contracture, or fistula formation that renders the bladder non-functional.
-
Refractory Bladder Dysfunction
Severe neurogenic bladder or other conditions causing dangerous urinary retention or incontinence that cannot be managed by other means may ultimately require diversion to protect the kidneys and restore quality of life.
-
Complex Fistula Disease
Connections between the bladder and bowel or vagina that cannot be repaired — particularly in the setting of prior radiation — may require diversion as a definitive solution.
Types of urinary diversion
There are three main types of urinary diversion, each with meaningful differences in how urine is managed day-to-day. Understanding these differences is essential before making a decision.
Ileal Conduit (Urostomy)
A short segment of small intestine (ileum) is used to create a conduit — a passageway — connecting the ureters to a stoma (a small opening) on the abdominal wall. Urine drains continuously through the stoma into a small external pouch worn against the skin.
The ileal conduit is the most widely performed urinary diversion because of its relative simplicity, reliability, and shorter operative time. It does not require the patient to perform any self-catheterization. The external pouch is emptied several times a day and changed regularly. A specialized ostomy nurse provides training before and after surgery.
Advantages
- Technically simpler and shorter surgery
- No manual drainage or catheterization required
- Well-established long-term track record
- Suitable for most patients
Considerations
- Requires lifelong use of an external pouch
- Daily stoma care and pouch management
- Visible under clothing without concealment
- Adjustment to body image change
Continent Cutaneous Reservoir (Indiana Pouch)
A reservoir (pouch) is constructed from a segment of bowel and connected to a continent stoma on the abdominal wall. Unlike the ileal conduit, urine is stored inside the body in the pouch rather than draining continuously into an external bag. The patient inserts a catheter through the stoma several times a day to drain the reservoir — no external pouch is worn.
The Indiana Pouch is the most commonly used continent reservoir design. It requires good hand function and the commitment to catheterize reliably on schedule — typically every 4–6 hours. The stoma is small and flush with the skin, easily concealed under clothing.
Advantages
- No external urine collection bag
- Stoma easily concealed
- Urine stored internally between catheterizations
- Greater sense of bodily normalcy for many patients
Considerations
- Requires reliable self-catheterization every 4–6 hrs
- Needs good manual dexterity
- Longer, more complex surgery
- Pouch complications possible over time
Orthotopic Neobladder
A new bladder is fashioned from a segment of bowel and connected directly to the urethra — the same outlet the native bladder used. This allows the patient to urinate through the urethra in a more natural way, without any stoma or external pouch. Many patients void by relaxing the pelvic floor and using abdominal pressure; some require intermittent self-catheterization through the urethra if retention develops.
The neobladder most closely approximates normal urinary function. However, it is not suitable for everyone — it requires an intact, functional urethra with no cancer involvement, adequate kidney function, and a patient willing and able to manage a period of retraining and possible leakage, particularly at night.
Advantages
- No stoma or external appliance
- Urination through native urethra
- Most similar to pre-surgery function
- Often preferred for body image
Considerations
- Not suitable for all patients or cancer cases
- Risk of incontinence (especially nighttime)
- Possible need for self-catheterization
- Requires intact urethra free of cancer
- Longer recovery and retraining period
How we decide which diversion is right for you
There is no universally superior option. The right diversion depends on a careful conversation that weighs medical, anatomic, and personal factors together. Dr. Wiegand will walk through all of these with you before any decision is made.
Age & Overall Health
Longer, more complex diversions carry higher surgical risk. Overall fitness for surgery influences which options are appropriate.
Kidney Function
Adequate kidney function is required for continent diversions and neobladder. Impaired function may favor a simpler conduit.
Prior Surgery or Radiation
Previous pelvic surgery or radiation changes tissue quality and anatomy, affecting which bowel segments can be safely used and how well they heal.
Cancer Location
Urethral involvement by cancer precludes neobladder. Margins and lymph node status may affect surgical planning.
Dexterity & Cognitive Function
Continent diversions and neobladder require reliable self-care — catheterization, stoma management, or voiding retraining. This must be realistic for the patient.
Lifestyle & Personal Goals
Some patients strongly prefer no external appliance; others prioritize simplicity and reliability over bodily normalcy. Both are valid and respected.
Bring someone with you
This is one of the most consequential decisions in reconstructive urology. Dr. Wiegand encourages patients to bring a family member or trusted person to consultations, and to take whatever time is needed to feel comfortable with the choice.
What to expect after urinary diversion
After Urinary Diversion Surgery
Dr. Lucas Wiegand · Florida Reconstructive Urology · (877) 876-3627
Hospital Stay & Initial Recovery
- • Hospital stay typically 5–10 days
- • Catheters and surgical drains used temporarily during healing
- • Full recovery: 6–12 weeks
- • Pain managed with oral medications
- • Diet advanced gradually as bowel function returns
Stoma & Catheter Training
- • A specialized ostomy/wound nurse will work with you before and after surgery
- • Conduit patients learn pouch application and stoma care
- • Continent reservoir patients learn self-catheterization technique
- • Neobladder patients receive voiding retraining guidance
- • Ongoing nursing support available after discharge
Possible Risks
- • Infection or bleeding
- • Bowel complications (obstruction, leak)
- • Urine leak or drainage difficulty
- • Stoma complications (conduit/reservoir)
- • Long-term: kidney function, stone formation, vitamin B12 absorption
Call Our Office If You Have
- • Fever >101°F
- • Severe or worsening pain
- • Nausea, vomiting, or inability to eat
- • No urine output or markedly reduced drainage
- • Redness, swelling, or drainage from surgical sites
Facing a decision about urinary diversion?
Dr. Wiegand offers thorough consultations covering all options, with time to ask questions and bring family members. There is rarely a reason to rush.
Request a Consultation