Urinary Diversion

Urinary diversion is reconstructive surgery to reroute the flow of urine when the bladder is being removed (usually for bladder cancer) or is no longer able to function. It is also used for severe neurogenic bladder, radiation-damaged bladder, and end-stage inflammatory bladder disease such as ketamine cystitis. A segment of small bowel (ileum) is used to create either a conduit that drains to a stoma on the abdomen, an internal continent reservoir, or a neobladder that connects to the urethra.

There are three main options: an ileal conduit (urostomy), where urine drains continuously into an external bag worn on the abdomen; an orthotopic neobladder, where a new bladder is built from bowel and connected to the urethra so you can void naturally through the penis; and a continent cutaneous diversion (Mitrofanoff), where an internal reservoir is drained several times a day through a small stoma at the umbilicus using a catheter — no external bag is needed.

Suitability depends on several factors, including your cancer stage and urethral involvement, kidney function, general fitness, manual dexterity for self-catheterisation (needed for Mitrofanoff and some neobladders), and personal preferences around stoma versus voiding. A neobladder gives the closest experience to normal voiding but requires a longer operation and a period of adjustment. Our team will discuss all three options with you in detail so the decision reflects both the clinical picture and what matters most to you.

Most patients stay in hospital for 7 to 14 days after urinary diversion surgery. The exact length depends on the type of diversion, how quickly your bowel function returns, and how comfortable you are with stoma care or self-catheterisation before discharge. Our enhanced recovery pathway prioritises early mobilisation, effective pain relief, and progression back to normal diet as soon as safely possible.

It depends on the type of diversion. An ileal conduit does not require catheterisation — urine drains continuously into a bag. A Mitrofanoff requires clean intermittent self-catheterisation four to six times a day through the stoma. A neobladder allows emptying naturally through the urethra although in most cases patients need to self-catheterise to empty the neobladder. You will be taught any required technique by our specialist nursing team.

Full recovery from urinary diversion is a gradual process over 6 to 12 weeks. Most patients feel much stronger by 6 weeks and are back to office-based work and light activities. Heavy lifting, contact sport and driving typically restart between 6 and 12 weeks depending on wound healing. Long-term, most patients live an active, full life — travel, swimming, exercise and intimacy all remain possible with appropriate preparation.

Long-term follow-up is essential and lifelong. This typically includes periodic renal function blood tests, cross-sectional imaging to check the upper tracts, and monitoring for bicarbonate, vitamin B12 and folate deficiency (as a segment of bowel has been used). Continent diversions also need surveillance for stoma or channel narrowing, stones within the reservoir, and reservoir capacity. Where the diversion was for bladder cancer, oncological follow-up continues in parallel.

Urinary diversion is most often performed alongside cystectomy (bladder removal), and the same operation may affect the nerves and blood vessels responsible for erections. Nerve-sparing techniques are used where oncologically safe. Erectile dysfunction after cystectomy is common, and a range of effective treatments — oral medications, vacuum devices, injections and penile implants — can restore sexual function. We routinely include sexual function in our pre-operative discussion and post-operative follow-up.