Continent Urinary Diversion
What is continent urinary diversion? Urinary diversion is a term used when the bladder is removed or the normal structures are being bypassed and an opening is made in the urinary system to divert urine. The flow of urine is diverted through an opening in the abdominal wall. Individuals who might require urinary diversion would be those whose bladders were non-functional or needed to be removed due to cancer or injury. Continent urinary diversion describes all forms of urinary diversion that enable the patient to urinate at his or her own discretion without the use of any form of appliance or collecting device. This form of urinary diversion can be broadly divided into two categories: cutaneous and orthotopic. Cutaneous continent urinary diversion refers to use of the gastrointestinal tract to create a new bladder, which is attached to the skin inside the body. This form of urinary diversion does not require the use of a collection appliance, however the patient is required to place a catheter or small plastic tube into their new bladder four to five times per day to empty the reservoir.
Orthotopic continent urinary diversion, commonly referred to as neobladder, most closely resembles the normal urinary anatomy. The intestinal tract is used to fashion a new bladder, which is then attached to the urethra in the pelvis. Patients then urinate spontaneously via the urethra and may be required to catheterize to ensure complete bladder emptying. This form of continent urinary diversion has been used in both men and women requiring cystectomy.