From the Guidelines
An ileal conduit, also known as an ileostomy for urinary diversion, is a surgical procedure where a segment of the ileum is used to create a pathway for urine to exit the body after the bladder has been removed or bypassed, as described in the context of preoperative counseling and stoma care in patients undergoing major extirpative surgery for muscle-invasive bladder cancer 1.
Key Aspects of the Procedure
- The procedure involves disconnecting the ureters from the bladder and attaching them to the isolated piece of ileum.
- One end of the intestinal segment is closed, while the other is brought through the abdominal wall to create a stoma on the skin surface.
- Urine continuously flows from the kidneys, through the ureters, into the ileal conduit, and out through the stoma into an external collection bag worn on the abdomen.
Importance of Preoperative Counseling and Stoma Care
- Preoperative education and counseling are crucial for patients undergoing this procedure, as they will be coping without their native bladders postoperatively 1.
- The patient’s abdomen should be evaluated, and the optimal site of stoma should be marked prior to surgery to reduce postoperative problems 1.
- Proper stoma care includes keeping the area clean, changing the appliance every 3-7 days, and monitoring for complications such as skin irritation, urinary tract infections, or stoma problems.
Postoperative Care and Follow-up
- Patients with a urostomy need to empty their collection pouch regularly, typically every 2-4 hours when awake, and use a larger night drainage system while sleeping.
- Regular follow-up with healthcare providers is essential to ensure kidney function remains normal and to address any complications promptly 1.
From the Research
Definition and Purpose of Ileal Conduit
- An ileal conduit, also known as an ileostomy for urinary diversion, is a type of urinary diversion that uses a portion of the intestine to create a conduit for urine to exit the body 2.
- This procedure is often performed after a radical cystectomy, where the bladder is removed, and a new way for urine to exit the body is needed 3.
Types of Urinary Diversion
- There are several types of urinary diversion, including incontinent urinary diversion (ureterocutaneostomy, ileal conduit, colonic conduit) and continent urinary diversion (continent urinary diversion, continent cutaneous urinary diversion, and urethral bladder substitution) 2.
- The choice of urinary diversion depends on various factors, including patient criteria (preference, age, comorbidity, BMI, motivation, underlying disease, and indication for cystectomy) and medical criteria 2.
Complications of Ileal Conduit
- Ileal conduit diversion can be associated with various complications, including renal deterioration, stenosis of the ileal conduit, upper urinary tract damage, and urolithiasis 4, 5.
- Stoma and skin complications are also common, and patients who practice inadequate stoma care routines are more likely to experience peristomal skin complications 4.
- Long-term follow-up is essential to monitor for potential complications and ensure timely intervention 5.
Management of Upper Urinary Tract Abnormalities
- Patients with ileal conduit urinary diversions are at an increased risk of long-term upper urinary tract complications, including anastomotic strictures, infections, and urolithiasis 6.
- Retrograde endourological management, such as ureteroscopy, can be used to diagnose and treat upper urinary tract abnormalities in patients with ileal conduit urinary diversion 6.
- This procedure can be technically challenging due to distorted anatomy, but it can be safely performed in experienced hands with standard endourological equipment 6.