Urinary Diversion

What makes up the urinary tract?

  • The kidneys, ureters, bladder, and urethra. Normal flow of urine through body:
  • Urine is produced in the left and right kidneys, then drains down to the bladder via the left and right ureters. Urine is then stored into the bladder, until the time of urination when urine travels out of the body via the urethra.

What is urinary diversion?

  • “Urinary diversion is a surgical procedure that reroutes the normal flow of urine out of the body when urine flow is blocked.”

Reasons to need urinary diversion:

  • “An enlarged prostate”
  • “Injury to the urethra”
  • “Birth defects of the urinary tract”
  • “Kidney, ureter, or bladder stones”
  • “Tumors of the genitourinary tract—which includes the urinary tract and reproductive organs—or adjacent tissues and organs”
  • “Conditions causing external pressure to the urethra or one or both ureters”

Temporary Urinary Diversion vs. Permanent Urinary Diversion:

  • Temporary urinary diversion maybe utilized if blocked urine flow is a temporary problem and urine needs to be rerouted for several days to months.
    • Forms of Temporary Urinary Diversion:
      • Nephrostomy Tubes:
        • A small tube is inserted into the kidney through the back and drains the urine into an external bag that can be emptied as it fills up. These can remain in place for weeks to months.
      • Urinary Catheterization
        • Foley catheter:
          • A small flexible tube that placed up the urethra into the bladder to drain urine into an external bag that can be emptied as needed.
          • If used long term should be changed monthly.
        • Suprapubic catheter:
          • A small incision is made in the lower abdomen and a small tube is inserted into the bladder to drain urine into an external bag that can be emptied as needed.
            • This can also be used for permanent urinary diversion.
            • If used long term should be changed monthly.
  • Permanent urinary diversion maybe utilized if blocked urine flow is a chronic problem and urine needs to be
    rerouted for the remainder of the patient’s life.

    • Forms of Chronic Urinary Diversion:
      • Urostomy:
        • A surgically created stoma, or artificial opening, is created in the abdomen and is connected to the urinary tract to drain urine. A bag attaches to the skin to collect urine. There is no muscle control in this form of urinary diversion, therefore there is a continuous flow of urine.
          • Ileal conduit: A portion of small bowel is removed from digestive tract and connected to urinary tract to transport urine to the stoma.
          • Cutaneous ureterostomy: One or both ureters are connected directly to the abdominal wall and skin to create a stoma.
      • Continent Urinary Diversion:
        • “Internal reservoir that a surgeon creates from a section of the bowel. Urine flows through the ureters into the reservoir and is drained by the patient. Continent urinary diversion does not require an external pouch.”
          • Continent Cutaneous Reservoir: “A surgically created valve keeps urine from flowing out of the stoma. The patient inserts a catheter through the continent stoma to drain urine from the reservoir several times throughout the day. The stoma is very small— less than 1-inch-wide—and sometimes can be hidden in the belly button.”
          • Bladder Substitute/Neobladder: “a surgeon creates an internal reservoir that connects to the ureters at one end and to the urethra at the other. Since this type of reservoir connects to the urethra, urine empties from the reservoir in a more natural process, just as a person with a normal urinary tract would do when going to the bathroom with a natural bladder.”
            • Increased risk of incontinence with bladder substitute/neobladder
              • Only certain people qualify for this type of procedure, decision would be made by the surgeon if patient is appropriate candidate.
  • Caring for your Nephrostomy tube(s) or Foley Catheter:
    • Nephrostomy tubes:
      • Monitor that urine is draining well from the nephrostomy tube. Ensure dressing is dry and intact. Do not tug or pull on your nephrostomy tube. You may need to flush your nephrostomy tube with 10mL of normal saline as needed or on a regular basis (to be determined by your healthcare provider). You may see blood in nephrostomy tube/bag, if this occurs increase hydration. If nephrostomy tube stops draining, becomes clogged, or you notice a decrease amount of output, notify your healthcare provider or go to the emergency room.
    • Foley Catheter:
      • Monitor that urine is draining well from the Foley catheter. Ensure catheter is secured to upper thigh, via a catheter securement device. It is common to have bladder spams, which can result in leaking of urine around the catheter. If you are going to have a catheter for an extended period time, there is medication that can help with this, please speak with your healthcare provider. There are two size bags available for urine collection: a small leg bag, which can be secured to your leg and wore under your pants or a large bag which can be used for overnight urine collection.
        • Men: if you develop irritation on the end of your penis from the catheter, apply a generous amount of Neosporin around the catheter insertion site.

Please do not hesitate to contact our office with questions or concerns.

Reference: National Institute of Diabetes and Digestive and Kidney Diseases. (2013). Urinary Diversion. Retrieved May 14, 2020. https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-diversion