What is an ileal conduit?

Ileal Conduit: A Common Form of Urinary Diversion

An ileal conduit is a type of urinary diversion procedure where a segment of ileum (small intestine) is isolated and used to create a conduit between the ureters and the abdominal wall, requiring patients to wear an external collection appliance for urine. 1

Definition and Basic Anatomy

• An ileal conduit is created by isolating a segment of ileum, while preserving its blood supply, and using it to form a tube or conduit 1
• The ureters are implanted into one end of this ileal segment, and the other end is brought through the abdominal wall to create a stoma on the skin surface 1
• Urine flows from the kidneys, through the ureters, into the ileal segment, and then out through the stoma into an external collection bag 2
• The stoma is typically placed on the right side of the abdomen, though modified techniques can place it on the left when necessary 3

Clinical Context and Indications

• Ileal conduits are most commonly performed following radical cystectomy (surgical removal of the bladder) for bladder cancer 1
• It is considered the gold standard urinary diversion to which newer forms are compared 4
• This procedure is particularly recommended for:
  • Elderly patients 5
  • Patients with limited manual dexterity 2
  • Those with poor motivation for self-catheterization 5
  • Patients with anatomical restrictions 5
  • Individuals with poor renal function 5

Surgical Procedure

• The procedure involves:
  1. Isolating a 15-20 cm segment of ileum while preserving its blood supply 1
  2. Restoring bowel continuity by anastomosing the remaining ileum 1
  3. Implanting the ureters into the proximal end of the ileal segment 1
  4. Bringing the distal end through the abdominal wall to create a stoma 1
• Modified techniques include:
  • The anterior ileal conduit, which leaves the conduit in its natural isoperistaltic anterior position 6
  • Left-sided placement when anatomical considerations require it 3

Preoperative Considerations

• Patients must be thoroughly educated about their urinary diversion options before surgery 2
• Meeting with an enterostomal therapist is essential for optimal stoma site marking 2
• Assessment of the patient's ability to manage an external collection device is important 2, 5

Complications and Long-term Outcomes

• Long-term studies show a high rate of complications in patients surviving more than 5 years with an ileal conduit 4
• In patients surviving more than 15 years, up to 94% experience complications 4
• Common complications include:
  • Kidney function deterioration/morphological changes (27% of patients) 4
  • Stoma-related issues (24%) 7, 4
  • Bowel complications (24%) 4
  • Urinary tract infections including pyelonephritis (23%) 4
  • Conduit/ureteral anastomosis problems (14%) 4
  • Urolithiasis (9%, increasing to 38% after 15 years) 4
• Stenosis of the ileal conduit may develop insidiously many years after the diversion 7

Follow-up and Monitoring

• Vigorous long-term follow-up is essential due to the high rate of complications 4
• Follow-up should include:
  • Regular assessment of renal function 4
  • Imaging of the upper urinary tract 1
  • Stoma examination 7
  • Urine cytology 1
• Patients should be followed in specialized stoma centers 7

Quality of Life Considerations

• Despite requiring an external collection device, quality of life is generally preserved with ileal conduit diversion 5
• For many elderly patients, quality of life may actually improve with this type of diversion compared to managing bladder dysfunction 5
• Proper stoma care is essential to prevent skin complications and maintain quality of life 7