Rigi10™ Malleable Penile Prosthesis
Also Known As
Bricker ileal conduit, Bricker conduit, IC, ileal loop urinary diversion, incontinent urinary diversion, urostomy
Definition
An ileal conduit is a surgical urinary diversion procedure that creates an alternative pathway for urine to exit the body after bladder removal (radical cystectomy).1 In this procedure, a surgeon isolates a short segment of the terminal ileum (approximately 15 cm), disconnects the ureters from the bladder, and implants them into this newly formed intestinal reservoir.2 The proximal end of the conduit receives the ureters, while the distal end is brought through the abdominal wall to create a stoma on the skin surface.3 Unlike continent diversions, the ileal conduit does not store urine but rather serves as a passive conduit for continuous drainage of urine from the kidneys to an external collection device.4 This procedure is considered the gold standard urinary diversion technique against which all others are measured, having been first described by Bricker in the 19th century and developed in the 1950s.5
Clinical Context
The ileal conduit is the most common form of urinary diversion performed by urologists, particularly after radical cystectomy for bladder cancer.1 Clinical indications include conditions requiring bladder removal such as muscle-invasive bladder cancer (T2-T4a), non-muscle invasive bladder cancer that has failed less radical management (e.g., BCG therapy or recurrence after TURBT), and severe neurogenic bladder conditions with intractable incontinence or chronic pelvic pain syndromes in females.2,5
Patient selection criteria favor elderly patients and those with impaired renal function because the bowel segment used is short, minimizing contact time with urine and reducing metabolic complications.6 The procedure is also preferred for patients with limited manual dexterity, cognitive impairment, or those unable to manage more complex continent diversions.7
The surgical procedure involves four main stages: isolating a 15 cm ileal segment located 15 cm from the ileocecal junction, mobilizing the ureters while preserving their blood supply, performing ureteroenteric anastomosis (using either Bricker or Wallace technique), and creating a stoma on the abdominal wall.8
Post-operative care includes stoma management with an external collection appliance consisting of an adhesive skin barrier and a drainage pouch.9 Expected outcomes are generally favorable, though long-term complications can include stomal stenosis, parastomal hernia, urinary tract infections, and metabolic disturbances such as hyperchloremic metabolic acidosis due to the absorption of urinary components through the ileal mucosa.4,7