When the bladder is removed... Let's learn about surgeries that change the way urine flows (Urinary Diversion)

Imagine that your bladder had to be removed for some reason, or it is not working properly. Then how does the urine that is produced in the body come out? You must have had this problem too. That is when doctors turn to what is called 'urinary diversion surgery' or Urinary Diversion . Although this may seem like a complicated topic, today we will talk about it simply, in a way that you can understand.

First, let's look at how our urinary system works.

To understand this, we first need to understand the normal process of urine formation and excretion in our body. It's very simple.

• Kidneys: These are like two water filters. They filter our blood, remove unwanted waste products and excess water, and make "urine."
• Ureters: Urine produced in the kidneys is carried to the bladder through two tubes. These two tubes are called ureters.
• Bladder: This is like a small balloon. It is a bag that collects and stores urine.
• Urethra: When the bladder is full, urine exits through this tube.

This entire process is controlled by a neural connection between the brain and the bladder. When the bladder is full, a signal is sent to the brain. The brain then tells the bladder to contract and the muscles in the urinary tract to relax.

Why would someone need this kind of surgery?

This surgery is only necessary when the bladder is not working properly or needs to be removed. There can be several reasons for this.

• Bladder cancer .
• Bladder damage caused by radiation therapy for cancer.
• Chronic bladder infections that occur frequently and do not heal.
• Severe trauma to the urinary system.
• Birth defects like spina bifida.
• Diseases of the nervous system such as Multiple Sclerosis (MS) .
• Severe incontinence or unbearable pain in the bladder.

What are these types of surgeries?

Simply put, surgeons use a small section of your own intestine to create a new path for urine to exit. This is done in two main ways. Let's look at the two methods in a way that's easy to understand.

Incontinence method: Ileal Conduit

This is the most commonly used method. Here you cannot control the flow of urine. It automatically collects in the bag.

• Advantages:
• The surgery is simpler than other methods.
• There is no need to self-catheterize.
• Disadvantages:
• Some people may feel psychologically uncomfortable wearing a bag that collects urine.
• The bag may leak or develop an odor.

Ways to pass urine with control

1. Indiana Pouch

In this method, a pouch made of intestine is placed inside the body. The urinary tract is connected to this. A small part of the intestine, which is connected to this pouch, is brought to a small opening (stoma) made in the abdomen. Urine does not come out of this on its own. About every four hours, you have to manually insert a small tube (catheter) through this opening to empty the urine in the pouch.

• Advantages:
• Since urine is contained within the body, there is no need for an external bag.
• There is less risk of leaks or odors because there is no bag.
• The stoma can be kept closed with a plaster.
• Disadvantages:
• The surgery takes a long time.
• You have to insert a tube and empty your bladder at regular intervals, about every four hours.
• Sometimes the opening can become blocked, scar tissue can form, stones can form inside the pouch, or infections can occur.
• Very important: If for some reason the tube cannot be inserted and the bag cannot be emptied, it may burst. This is a medical emergency. In such a case, you should immediately go to the hospital's Emergency Department (ETU).

2. Creating a new bladder (Neobladder)

This is the closest thing to a normal urinary tract. Here, a new bladder made from the intestine is connected to your original urethra. So there is no external opening (stoma). When you need to urinate, you have to contract your abdominal muscles to do so.

• Advantages:
• The process of urination is very similar to the normal method.
• There is no external opening (stoma) to take care of.
• Disadvantages:
• The surgery takes a long time.
• You may experience some incontinence for about six months after surgery. Some people may experience this condition at night.
• Some people are unable to completely empty their new bladder. They may also need to have a tube inserted through the urethra, either temporarily or permanently, to empty their urine.

How is the recovery time after surgery?

It can take a month or two to fully recover and regain strength after a surgery like this. It also takes some time to get used to the new system. You need to be patient with that.

• Work: You can usually return to work within a month or two.
• Activities: Once you have recovered, you can return to exercise and sports. However, consult your doctor before engaging in contact sports or swimming.
• Diet: The doctor advises eating soft, easy-to-digest foods for the first month after surgery.
• Travel: There is no restriction on travel. However, please carry additional supplies (ostomy bags, catheters) with you.

This surgery can affect you both physically and mentally . It is normal to feel anxious and worried about your sex life and your relationship with your partner with this new situation. It is very important to talk openly about this with your doctor.

What time should I see the doctor?

If you experience symptoms of a urinary tract infection, see your doctor immediately.

• Fever
• Shivering due to cold
• Nausea or vomiting
• Back or abdominal pain
• Urine changes color (darkening) or has a strong odor

Additionally, if the skin around your stoma becomes red, swollen, pus or urine leaks, or if you have difficulty inserting the catheter, notify your doctor immediately.

Bladder removal, Urinary Diversion, Cystectomy, Urostomy, Neobladder, Stoma, Urine bag