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Urinary diversion involves rerouting urinary drainage to the outside of the body—either as a temporary or permanent solution. This activity outlines incontinent urinary diversion techniques, namely ileal conduits, and highlights the interprofessional team's role in evaluating and treating patients who undergo such surgery. Objectives: Identify the indications for ileal conduits. Determine the equipment needed for ileal conduits. Assess the potential complications of operations involving ileal conduits. Access free multiple choice questions on this topic.

Urinary diversion involves re-routing urinary drainage outside the body as a temporary or permanent solution. Commonly, a permanent urinary diversion is created after surgery to treat a bladder or pelvic malignancy. Still, it can be performed for other functional and anatomical urinary tract abnormalities. They can be classified as percutaneous, continent, or incontinent. In this chapter, we focus on incontinent diversion, of which there are 2 types: cutaneous ureterostomy and intestinal or ileal conduit. Ureterostomy is rarely used and usually only as a last resort in salvage procedures. Ileal conduits are the most common form of incontinent urinary diversion. Other options for continent urinary diversion do exist, and these are more widely practiced in America, whereas in Europe, ileal conduits are preferred. Ileal conduits are the gold standard urinary diversion technique against which all others are measured today.[1][2] It is a passive conduit for urine to drain into an appliance. Bricker first described it in the 19th century and developed it in the 1950s.[3] It is thought to have originally been developed by French surgeons during World War II. Still, the technique did not become prominent until 1950, when an effective adhesive appliance for ileostomy was introduced. As time has passed and oncological and surgical techniques have evolved, selecting the right patients for an ileal conduit has become more refined along with the surgical approach.

Urinary conduits are often considered easier to perform than continent diversions as the surgical technique is less complicated and requires less time. An ileal conduit does not require anastomosis to the urethra; it also requires a shorter bowel segment to create the conduit. The conduit itself requires minimal augmentation when compared to a neobladder.[6]  Most of the complications of ileal conduits can be split into early (<90 days) and late (>90 days).[10][11] Early complications include those involving the bowel, such as obstruction, anastomotic leak, and ileus. Ileus can occur in up to 20% of cases and is often the reason for prolonged hospital admission. The urinary leak is also important and accounts for about 7% of complications.[12] This often occurs due to tension at the anastomosis Delayed complications include those involving the newly formed stoma, such as parastomal hernia, retraction or stenosis, and bleeding. Frequent urinary tract infections (UTIs) can often be a problem for patients, and up to 6% end up dying from end-stage renal failure. These patients are also predisposed to developing renal stones; ultrasound (USS) imaging can detect this. Metabolic complications can be significant; hence, regular follow-up is needed to ensure electrolytes are normal and the patient is not acidotic. Patients can struggle with the psychological impact of living with a stoma and should be appropriately counseled beforehand.

Despite the numerous papers in the literature, there is conflicting evidence and no clear advantage in the quality of life of orthoptic diversions over incontinent diversions.[6]  Psychosocial factors are an important consideration for patients undergoing this surgery. Up to two-thirds of patients with an ileal conduit require help from their spouse or another caretaker to take care of their appliance and urostomy. Still, with an aging population, many older people live alone with no one to help take care of them.[14] Due to stoma-related skin excoriation, stoma care is critical to prevent complications and associated decreases in quality of life. The journey from diagnosis through treatment and subsequent follow-up is challenging, and a support system is vital for successful patient outcomes. Preoperative counseling and shared decision-making are vital, with each individual's social factors taken into consideration, as they can drastically influence treatment plans.[6]