Ileal conduit surgery

Overview

Ileal conduit surgery creates a new way for urine to leave the body when the bladder is removed or does not work as it should. This type of surgery is called urinary diversion.

During surgery, a surgeon uses a short piece of the small intestine, called the ileum, to make a passage for urine. This passage is the ileal conduit. It leads to an opening in the belly, called a stoma. Urine drains through the stoma and collects in a pouch worn outside the body. This type of urinary diversion is called a urostomy.

An ileal conduit is permanent. Adjusting to life with a stoma and pouch can take time. As you recover, you can return to many of your usual activities.

An ileal conduit is different from an ileostomy. Both create a stoma in the belly. An ileal conduit carries urine out of the body. An ileostomy carries gas and stool out of the body.

Why it's done

An ileal conduit may be needed when the bladder must be removed or can no longer store and pass urine. Surgery to remove the bladder is called a cystectomy (sis-TEK-tuh-me). An ileal conduit gives urine another way to leave the body.

Reasons for bladder removal may include:

• Bladder cancer. This is the most common reason for bladder removal.
• Severe bladder inflammation or damage. Causes may include certain bladder conditions or radiation therapy.
• Nerve damage that affects the bladder. Damage to the nerves that control the bladder can keep the bladder from working as it should. This can happen with a spinal cord injury, multiple sclerosis or spina bifida, a condition that's present at birth.

Risks

Ileal conduit surgery can have complications. Your risk depends on your health and any other procedures you have at the same time.

Possible complications include:

• Bleeding, blood clots and infection. These may occur after any major surgery.
• Bowel complications. After surgery, the intestine may take time to start moving food and waste again. This is called ileus. A bowel blockage or a leak where the intestine was joined back together also can occur.
• Urine leak. Urine can leak from where the ureters join the ileal conduit.
• Urinary tract infection. An infection can develop in the urinary tract, including the kidneys. Symptoms may include blood in the urine, strong-smelling urine, pain in the belly or back, fever, or chills.
• Narrowing where the ureter joins the ileal conduit. This can block urine flow.
• Stoma complications. The stoma may narrow, pull inward or push out farther than expected. A bulge, called a parastomal hernia, also can form around the stoma. These issues may affect urine drainage or make it harder for the pouch to fit securely.
• Changes in the balance of acids and salts in the body. The part of the intestine used to make the conduit can take in substances from urine. Over time, this can change the balance of acids and salts in the body. Medicine can help correct the balance if needed.
• Changes in kidney function. The kidneys may not work as well over time after ileal conduit surgery. Your care team may check your kidneys during follow-up visits.

How you prepare

Your healthcare team gives you instructions to help you get ready. What you need to do may depend on the other procedures you're having at the same time.

• Tell your care team about the medicines, vitamins and supplements you take. You may need to stop or change some of them before surgery. Your care team tells you what to take or stop and when.
• Follow your care team's instructions about eating and drinking. If you're having bladder removal surgery, you may be asked to have only clear liquids for a short time. Your care team tells you when to stop eating and drinking.
• Stop smoking and using other nicotine products. Nicotine can slow healing and raise the risk of complications. Ask your care team for help if you need support to stop.
• Plan for your recovery. Arrange for someone to help you after you leave the hospital. You may need help with transportation, meals, medicines and other daily activities. Ask your care team how much time you may need away from work or school.

Choosing the stoma location

Before surgery, you may meet with an ostomy nurse, who has special training in stoma and pouch care. The nurse works with you to choose a place on your belly for the stoma.

The nurse may ask you to sit, stand or lie down while choosing the spot. The nurse also looks at skin folds, scars and how your clothing fits. The goal is to find a spot you can see and reach and where the pouch can fit securely.

What you can expect

Before the procedure

Before surgery, your care team talks with you about the procedure and answers your questions. If the stoma location hasn't already been marked, a member of your care team may mark it before surgery.

A healthcare professional places an IV in a vein to give you fluids and medicines.

Ileal conduit surgery is done using general anesthesia. General anesthetic is medicine that puts you in a sleeplike state during the procedure.

During the procedure

Ileal conduit surgery can be done with open or minimally invasive surgery. Open surgery uses one larger cut in the belly. Minimally invasive surgery uses several smaller cuts, a camera and special tools.

Minimally invasive surgery may be laparoscopic or robotic. With laparoscopic surgery, the surgeon holds and moves the tools. With robotic surgery, the surgeon uses a robotic system to control the tools.

During ileal conduit surgery, the surgeon uses the ileum to make the ileal conduit. The rest of the intestine is joined back together. This allows food and stool to keep moving through the intestine.

Next, the surgeon connects the ureters to the ileal conduit. The ureters are tubes that carry urine from the kidneys. One end of the conduit is brought through the skin of the belly to make the stoma.

Urine then flows from the kidneys through the ureters and ileal conduit. It leaves the body through the stoma and collects in a pouch.

The surgeon may put thin tubes called stents in the ureters. The stents help urine flow while the new connections heal. The ends of the stents may come through the stoma into the pouch. The stents are removed after the connections have had time to heal.

After the procedure

After surgery, you're taken to a recovery area. Members of your care team checks your surgical cut and stoma. They make sure urine flows through the ileal conduit and check for signs of complications. Then you're moved to a hospital room.

You receive medicine to help ease pain. As soon as you're able, your care team encourages you to get out of bed and take short walks. Walking can help with recovery.

Your intestine needs time to recover after surgery. Your care team lets you know when you can start to drink liquids and eat food again.

Your stoma may be swollen at first. This is expected. The swelling gets smaller as the stoma heals over the next several weeks.

An ostomy nurse teaches you how to care for your stoma and the skin around it. You also learn how to empty and change your pouch. An opening at the bottom of the pouch lets you drain the urine without removing the pouch.

How often you need to change the pouching system varies. You learn how to tell when it's time for a change. Keeping the skin around your stoma healthy helps the pouch fit securely and helps prevent leaks.

You may see mucus in the urine or pouch. This is expected. The piece of intestine used to make the conduit still makes mucus. The mucus passes through the stoma with the urine.

Before you leave the hospital, your care team explains how to care for your stoma at home. You also learn what to watch for and when to contact your care team.

Follow your care team's instructions for caring for your surgical cut. Contact your care team if you have a fever, chills, more swelling, new or more drainage from the cut, or pain that doesn't get better with pain medicine.

At follow-up visits, you may have blood tests. These tests check how well your kidneys are working and the balance of acids and salts in your blood. If the balance is off, medicine can help correct it.

Coping and support

Adapting to life with an ileal conduit can take time. You may have concerns about caring for your stoma, managing the urine pouch or how the pouch looks under your clothes. You also may feel sad, frustrated or self-conscious about changes to your body.

As you become more comfortable caring for your stoma and pouch, these concerns may become easier to manage. These tips may help:

• Give yourself time to adjust. You don't have to feel comfortable with these changes right away. Learning how to care for your stoma and pouch can help you feel more confident.
• Talk about how you're feeling. Sharing your concerns with family members, friends or others you trust may help. You decide how much you want to tell other people about your ileal conduit.
• Ask for help with stoma and pouch care. An ostomy nurse can help you learn how to care for your stoma and pouch and manage issues such as leaks or skin irritation.
• Connect with others. People who live with a stoma and pouch can share practical advice and encouragement. Ask your care team about support groups or other ways to connect with people who have had similar experiences.

As you recover, talk with your care team about returning to work, exercise, travel, sexual activity and other activities that are important to you.