What is an ileal conduit (ileal loop)?

From the Guidelines

An ileal conduit, also known as an ileal loop, is a surgical procedure that diverts urine away from the bladder by using a small segment of the ileum to create a tube or conduit, which is then connected to the ureters and brought through the abdominal wall to create a stoma on the skin surface. This procedure is commonly performed after bladder removal (cystectomy) due to bladder cancer, neurogenic bladder dysfunction, or other conditions where normal urinary function is compromised [ 1 ]. In this procedure, one end of the conduit is connected to the ureters, which carry urine from the kidneys, while the other end 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 then out through the stoma into an external collection bag worn on the abdomen.

Key Considerations

• Patients with an ileal conduit require lifelong stoma care, including regular changing of the collection appliance (typically every 3-7 days) [ 1 ].
• Monitoring for skin irritation around the stoma, maintaining adequate hydration, and watching for complications such as urinary tract infections, stomal stenosis, or electrolyte imbalances are crucial [ 1 ].
• The procedure works effectively because intestinal tissue is naturally well-vascularized and can be safely repurposed for urinary diversion without significantly affecting digestive function, as only a small segment of intestine is used.

Potential Complications

• Early high ostomy output, defined as ostomy output greater than fluid intake, can occur and requires prompt evaluation and treatment to prevent dehydration [ 1 ].
• Ostomy leakage is a common complication that can be prevented with preoperative marking by a stomatherapist and meticulous surgical technique [ 1 ].
• Management of leakage involves thickening the stool with antidiarrheals, pouching techniques, and using convex appliances or ostomy belts to bolster the height of the stoma off the peristomal skin [ 1 ].

From the Research

Definition of Ileal Conduit

• An ileal conduit, also known as an ileal loop, is a type of urinary diversion surgery where a portion of the ileum (the last part of the small intestine) is used to create a conduit for urine to exit the body 2, 3.
• This surgical procedure is often performed in patients with certain medical conditions, such as spinal cord injuries, spina bifida, or bladder cancer, where the normal flow of urine is disrupted 4, 5.

Purpose and Outcomes

• The primary goal of an ileal conduit is to provide a lifelong solution to urologic and social problems associated with urinary incontinence or retention 2.
• Studies have shown that ileal conduit urinary diversion can be an effective treatment for patients with end-stage renal disease due to abnormal lower urinary tracts 5.
• However, patients with an ileal conduit are at an increased risk of long-term complications, including upper urinary tract abnormalities, such as anastomotic strictures, infections, and urolithiasis 4.

Surgical Procedure and Considerations

• The surgical procedure for creating an ileal conduit involves dividing the ileum and using the isolated segment to create a conduit for urine to exit the body 3.
• Preoperative and postoperative considerations, such as assessing renal function and preventing infections, are crucial to ensure the success of the procedure 3.
• Retrograde ureteroscopy can be performed to diagnose and treat upper urinary tract abnormalities in patients with an ileal conduit, although it can be technically challenging due to distorted anatomy 4.

Patient Outcomes and Complications

• Studies have reported varying outcomes and complications in patients with an ileal conduit, including renal function deterioration, urinary tract infections, and stomal stenosis 2, 6.
• Patient survival and graft survival rates have been reported to be comparable to those in the normal transplant population, despite preexisting co-morbidity and increased complication rates 5.
• The perioperative morbidity rate and late complication rate should be considered when informing patients about the surgery 6.