When a surgeon removes all or part of the bladder, they create a new channel to allow urine to drain from the body. This type of surgery is called an ileal conduit. After surgery, a person will live with a urostomy bag that collects urine.
The healthcare team will explain to the person how to fit, change, and drain the bag. Once they have adapted their habits slightly, a person with a urostomy bag can live a full life.
This article will explain what an ileal conduit is and when and why doctors carry out this procedure. It will then examine what happens during the procedure.
An ileal conduit is a type of surgical procedure that puts in place a system to mimic the work of the bladder. It is the
A surgeon will remove part of the intestine to create a new pathway for the urine. They will then attach this piece of intestine to a hole in the abdomen called a stoma. Doing this allows the urine to drain into a urostomy bag or pouch.
An ileal conduit makes it possible for a person to pass urine even after a surgeon has removed their bladder or it has become damaged.
Surgeons may remove the bladder to treat invasive or recurrent cancers affecting the pelvis, such as:
Bladder surgery may also be necessary following spinal cord injury or damage to the bladder after cancer treatment. Some people may undergo this surgery to correct congenital abnormalities.
According to the United Ostomy Association of America, between 725,000 and 1 million people in the United States live with an ostomy bag, which refers to any kind of pouch that collects excrement, including urine.
Ahead of the procedure, a person should have a meeting with their surgeon to discuss the operation and any risks it may involve. It may also be possible to meet with the anesthetist to discuss managing pain after the surgery.
The doctor will ask the person whether they are taking any medications or have any allergies.
A specialist nurse may also examine how the person sits and ask them how they wear their clothes to determine the best place for the stoma.
Some doctors recommend that people take laxatives to empty their colon before surgery. However, some research suggests that this is unnecessary.
For example, a 2014 study evaluating the effects of mechanical bowel preparation — such as taking laxatives — before surgery concluded that it did not help reduce complications during surgery. However, the authors call for further trials to confirm this finding.
A surgeon will create the ileal conduit during the procedure in which they remove the bladder, so the person will be under general anesthesia. The surgery will usually take 2–6 hours.
During the procedure, the surgeon will remove 6–8 inches of the intestine. Removing this section will have no effect on the person’s bowel function.
The surgeon will also cut a small hole in the surface of the abdomen, which makes a stoma. They will then attach the intestine to the ureters at one end and the stoma at the other, forming a channel through which urine can pass and exit the body.
On waking up from surgery, a person may notice lots of attached tubes. Some of these tubes help drain the body of excess fluids, whereas others pass medication into the body to help with managing postoperative pain.
A nurse will take regular readings to check the following:
During this hospital stay, getting up and moving around according to a healthcare worker’s instructions will stimulate the bowels to start working again.
The person may be able to drink the day after the procedure and eat small amounts of solid foods over the next few days, depending on their appetite.
There may be some swelling or discharge in the genitals or groin after the procedure. However, this should disappear over a few weeks.
People should take care to use the correctly sized opening for their stoma as it heals. Tight openings may cause pain and damage by squeezing the stoma, while large openings may lead to leakages.
Common complications that can arise following ileal conduit procedures and bladder surgery include:
- Bowel sluggishness: A person may experience constipation or other symptoms in the bowel.
- Erectile dysfunction: During surgery, a surgeon will sometimes remove the nerves that help a person get an erection.
- Infection: The bowel, urine, or surgical wound may develop an infection.
- Blood loss: If blood loss continues for more than a few days after the surgery, treatment will be necessary.
A person should contact their doctor or surgeon if they experience the following symptoms after surgery:
- a fever higher than 101°F
- bloody or cloudy urine
- nausea or vomiting
- dislodged stents
- severe pain
- chest pain
- flushed skin or swelling around the incision
- swelling in the lower body
After surgery, an ostomy nurse will demonstrate how to clean the wound safely by washing it with antibacterial soap and gently patting it dry.
Although it is possible to live a full and active life with a pouch, it will be necessary to make some changes to everyday habits.
Some people may find it useful to join a support group for those with ostomy bags.
Draining and changing the pouch
A person can learn to fit and change the pouch that will collect the urine.
They will need to drain the pouch several times a day or when it is one-third to one-half full. They should change the pouch every 3–7 days. It is important always to wash the hands before touching the stoma or pouch.
Over time, draining and changing the pouch will become as routine as visiting the bathroom. Planning ahead and knowing where public restrooms are may help reassure people living with urostomy pouches.
From 3 days after surgery, a person can shower, although they will likely require help to do so. Showering every day is a good way to keep the incision clean.
An ileal conduit is a procedure that surgeons carry out alongside bladder removal or following bladder damage to help drain the body of urine.
The procedure carries some risks, including bowel complications and infections.
Many people live full and active lives with an ostomy pouch once they have adapted to living with it.