Rigi10™ Malleable Penile Prosthesis
Also Known As
Urinary reconstruction, urine diversion, urinary tract diversion, bladder diversion, urostomy, ileal conduit, cutaneous ureterostomy, continent urinary reservoir, neobladder, orthotopic neobladder, Indiana pouch
Definition
Urinary diversion is a surgical procedure that creates a new pathway for urine to exit the body when the normal flow of urine is blocked or when there is a need to bypass a diseased area in the urinary tract.1 This procedure is typically performed following the removal of the bladder (cystectomy) or when the bladder function is compromised due to disease or injury.2 Urinary diversions can be categorized into continent and incontinent types, each serving the dual functions of urine storage and elimination through different anatomical configurations.3 The procedure involves rerouting the ureters, which normally carry urine from the kidneys to the bladder, to either an external collection device or to a newly created internal reservoir constructed from segments of the intestine.4
Clinical Context
Urinary diversion is primarily indicated for patients undergoing radical cystectomy due to muscle-invasive bladder cancer, which is the most common reason for this procedure.1 Other clinical indications include neurogenic bladder dysfunction resulting from spinal cord injuries or congenital anomalies such as spina bifida, chronic bladder inflammation or infection, severe urinary incontinence unresponsive to standard treatments, and radiation-induced bladder damage.2
Patient selection for specific types of urinary diversion depends on multiple factors including age, body habitus, manual dexterity, cognitive function, renal function, and patient preference.3 Preoperative assessment includes evaluation of renal function, upper urinary tract imaging, and assessment of bowel segments to be used for reconstruction.4
The main types of urinary diversion include:
1. Incontinent Diversions:
- Ileal Conduit: The most common form, where a segment of ileum is used to create a conduit from the ureters to a stoma on the abdominal wall, requiring an external collection bag.5
- Cutaneous Ureterostomy: Direct attachment of one or both ureters to a stoma on the abdominal wall.1
2. Continent Diversions:
- Continent Cutaneous Reservoir (Indiana Pouch): Creation of an internal pouch from bowel segments with a valve mechanism, allowing for catheterization through a stoma to empty urine.3
- Orthotopic Neobladder: Construction of a new bladder from intestinal segments connected to the urethra, allowing for near-normal voiding through the urethra.4
Postoperative care includes stoma management for patients with external diversions, catheterization training for those with continent diversions, monitoring for metabolic abnormalities, and regular follow-up to assess renal function and detect potential complications.5
Expected outcomes vary by diversion type, with satisfaction rates being similar across different options when patients are appropriately selected and educated. Recovery typically takes 6-8 weeks, with adaptation to new voiding patterns continuing for several months.3