Urinary diversion

In the case of urinary bladder tumors that cannot be treated endoscopically (link) or benign diseases that are associated with a loss of bladder function, there is an indication for removal of the urinary bladder.

After the urinary bladder has been removed, which has to be carried out with varying degrees of radicality depending on the indication, surgical diversion of the urine is necessary.

This is done via a so-called urinary diversion. A distinction is made here between “incontinent” and “continent” urinary diversions. With incontinent urinary diversion, the urine flows directly into a collection bag without intermediate storage. During continent urinary diversion, the urine is first temporarily stored in a reservoir made from the intestine. This reservoir can be emptied in a controlled manner by the patient.

The following forms of “continent” urinary bladder replacement are carried out at high frequency at our clinic:

Orthotopic neobladder

Here, a new urine reservoir, i.e. a “replacement bladder”, is formed from the intestine, into which the two ureters from the kidneys are implanted. The urine can be stored in this neobladder. This reservoir is then sutured to the urethra at its lowest point. The new bladder is connected to the urethra at the location of the old bladder (orthotopic). Thanks to the functioning sphincter, the neobladder can be emptied in a controlled manner by the patient. 

Catheterizable pouch

A loop of intestine is used to form a urine reservoir (pouch) into which the two ureters are implanted. A catheterizable “drainage valve” is then created from a piece of intestine and drained out at the belly button. Through this umbilical stoma, the patient can empty the urine stored in the pouch using a catheter. A special implantation technique ensures that the emptying of urine can be controlled at will.

If there are contraindications for a continent urinary diversion or if this is not primarily desired, incontinent urinary diversion can be considered. The urine is directed into a collection bag. The most commonly performed variant is the so-called ileal conduit, in which the ureters are implanted into a short piece of intestine and this is in turn sewn into the abdominal wall. The urine then flows freely into a glued-on stoma bag, which must be emptied regularly. If this form of urinary diversion is not possible, the ureters can also be implanted directly into the abdominal wall and the urine is also drained into a stoma bag.

If you have any questions about which form of urinary diversion is recommended for you, we offer you the opportunity to present yourself at our second opinion consultation hours (link) or at the consultation hours for self-payers and privately insured patients (link).

You are welcome to request a detailed patient guide on the subject of urinary diversion as part of our study  - Prospective evaluation of the knowledge gained through the brochure "Patient guide to urinary diversion before a planned cystectomy" ("Patientenratgeber Harnableitung" vor geplanter Zystektomie)- from the following contact: 

Mandy Ehrt
+49 351 458-2447
email: urologie