Urinary Diversion
Urinary diversion encompasses the reconstructive options used when the native bladder is removed, bypassed, or no longer suitable for storage and emptying. At a practical level, the major families are ileal conduit, orthotopic neobladder, continent cutaneous diversion, and cutaneous ureterostomy — each trading operative complexity, continence goals, metabolic burden, and long-term maintenance in different ways.
General Principles
- Principles of Urinary DiversionDetubularization, spherical reservoir design, bowel-segment physiology, ureteroenteric anastomosis, continence mechanisms, patient selection, metabolic surveillance, and lifelong follow-up.
9 of 9 diversions
| Diversion | Family | Notes |
|---|---|---|
| Ileal Conduit | Incontinent | The most common urinary diversion. Short ileal segment anastomosed to the ureters and matured as a cutaneous urostomy; lowest operative complexity and no need for self-catheterization, but requires a permanent external appliance. |
| Cutaneous Ureterostomy | Incontinent | Direct ureter-to-skin diversion that avoids bowel anastomosis and minimizes operative time. Best suited to elderly, frail, or highly comorbid patients when surgical simplicity outweighs long-term stoma and stenosis concerns. |
| Hautmann Neobladder | Continent Orthotopic | W-shaped detubularized ileal reservoir anastomosed to the native urethra. Allows voiding per urethra through the intact sphincter mechanism in carefully selected patients. |
| Modified Studer Pouch | Continent Orthotopic | Widely used orthotopic neobladder built from detubularized ileum with a long isoperistaltic afferent limb for ureteral implantation and upper-tract protection. |
| T-Pouch Modification | Continent Orthotopic | Orthotopic neobladder variant using T-limb reservoir geometry to optimize pouch shape and ureteroenteric configuration within the neobladder family. |
| Indiana Pouch | Continent Cutaneous | The most established continent cutaneous diversion in North America. Uses detubularized right colon with a catheterizable, continent outlet that is emptied intermittently through an abdominal stoma. |
| Right Colon Pouch | Continent Cutaneous | Detubularized right-colon reservoir with a catheterizable continence mechanism. Shares the same low-pressure storage logic as the Indiana pouch and is useful when colonic tissue is preferred. |
| Double T-Pouch | Continent Cutaneous | Catheterizable continent reservoir using a double-T ileal configuration for patients who want continence without an orthotopic urethral outlet. |
| Colostomy Shuffle | Complex / Salvage | Complex bowel rerouting maneuver used in select exenterative or combined urinary-fecal reconstruction scenarios when standard diversion pathways are not feasible. |