Ileal Conduit Procedure - Healthnile.com

Overview

An ileal conduit is a surgical procedure that creates a new pathway for urine to leave the body after bladder removal or damage. Surgeons use a small piece of the small intestine, called the ileum, to form a tube. This tube connects the kidneys to an opening, or stoma, on the outside of the abdomen. Urine drains from this stoma into a special bag.

This type of urinary diversion is common after certain bladder surgeries, such as removal due to cancer or injury. People may feel unsure about living with a stoma and urine bag, but learning about the process can ease concerns and improve confidence in daily care.

What Is the Ileal Conduit Procedure?

Surgeons often perform the ileal conduit procedure to reroute urine after the bladder is removed or stops working. They create a new path for urine to exit the body using part of the small intestine.

Purpose of an Ileal Conduit

Surgeons usually perform an ileal conduit after bladder removal, most often because of cancer or severe bladder disease. When the bladder cannot hold or expel urine, the body still needs a way to get rid of waste.

This surgery diverts urine from the kidneys, bypassing the bladder entirely. The surgeon attaches the ends of the ureters, which carry urine from the kidneys, to a small piece of the ileum. This forms a new channel so that urine can be collected in a special bag outside the body, called a urostomy pouch.

Some people may need an ileal conduit if their bladder is damaged from injury, birth defects, or other serious problems. Doctors consider this option only when other treatments for bladder function are not possible or have failed.

Anatomy of the Ileal Conduit

The ileal conduit uses a short segment of the ileum, part of the small intestine. Surgeons separate this section and keep its blood supply. They reconnect the rest of the intestine so digestion continues normally.

Surgeons surgically join the urine-carrying ureters to one end of the ileum segment. They bring the other end of this segment through a small opening in the belly, called a stoma. This stoma becomes the new exit point for urine.

A urostomy pouch is worn over the stoma to collect urine. The stoma does not have muscles, so urine comes out constantly and is collected in the external bag. Below is an outline of the main parts:

Part	Role
Ureters	Carry urine from kidneys
Ileum segment	New urine channel
Stoma (ostomy)	Opening on the abdomen
Urostomy bag	Collects urine

Difference from Other Urinary Diversions

Several types of urinary diversion surgeries exist, but the ileal conduit is usually the simplest and most widely used. Unlike some other methods, patients do not need to insert a tube (catheter) themselves to empty urine. The main differences are:

Ileal Conduit: Uses the ileum and requires the person to wear a bag.
Continent Urinary Diversion: Uses a pouch made from bowel, and the person drains urine by inserting a catheter a few times a day.
Orthotopic Neobladder: Tries to create a new bladder from intestine, so a person can still urinate through the urethra, but not everyone is a candidate.

The ileal conduit is often preferred for its reliability and lower maintenance requirements, especially among older adults or those with additional health conditions. While some people may feel self-conscious about having a stoma and wearing a bag, many learn to manage it successfully with support and guidance from healthcare providers.

Indications for Ileal Conduit Surgery

Surgeons most often perform the ileal conduit procedure when the bladder can no longer function or must be removed. They recommend this surgery in cases involving cancer, severe bladder dysfunction, or major injury.

Bladder Cancer and Other Malignancies

Bladder cancer is the most common reason for ileal conduit surgery. Many patients who have invasive bladder cancer require removal of the bladder, called a cystectomy or radical cystectomy. After the bladder is removed, an ileal conduit gives a new way for urine to leave the body.

Other pelvic cancers, such as cancers of the prostate, uterus, or cervix, may also lead to removal of the bladder if the cancer has spread. The ileal conduit helps maintain a way for urine drainage after bladder removal, reducing risks of urine backup and infection. In these cases, surgeons use the ileal conduit because other forms of reconstruction may not be safe or possible due to cancer location or extent.

Neurogenic and Severe Bladder Dysfunction

Neurogenic bladder is a problem where nerves that control the bladder no longer work correctly. This condition can happen after spinal cord injury, multiple sclerosis, or other nerve diseases. When someone cannot safely empty their bladder, serious complications such as kidney damage and repeated urinary tract infections may occur.

For some people, medical treatments and less invasive surgery do not help. The ileal conduit then becomes an option to direct urine away from the body. It allows the kidneys to drain urine consistently, protecting kidney health. People with severe bladder dysfunction from birth defects or chronic disease may also need this procedure if other treatments fail.

Trauma and Other Medical Conditions

Major injury to the pelvic area or bladder may sometimes make normal urination impossible. In cases such as car accidents or severe pelvic fractures, the bladder can be damaged beyond repair. Surgeons perform emergency surgery to create an ileal conduit, helping the body get rid of urine and reducing further medical risks.

Other rare conditions, such as severe infections or radiation injury after cancer treatment, may also cause permanent damage to the bladder. When the bladder can no longer store or release urine, doctors consider an ileal conduit to maintain urinary function. Doctors decide on ileal conduit surgery based on how much the bladder is damaged and whether other treatments are likely to work.

Preoperative Preparation

Proper preparation before an ileal conduit procedure helps improve recovery, lower risks, and support patient wellbeing. This covers medical assessments, physical steps such as bowel cleansing, and emotional readiness for surgery.

Consultations and Assessment

A healthcare provider arranges a thorough preoperative consultation. The provider reviews the patient’s medical history and discusses current medications and allergies. Physical exams and lab tests check kidney function, blood health, and infection risk. An ostomy nurse may assess the abdomen to pick a good stoma site, looking for areas away from bony points or scars.

Urologists and anesthesiologists provide input to ensure the patient is fit for surgery. Before surgery, the healthcare team closely monitors the patient’s health status. They may recommend stopping certain medications or managing conditions like diabetes to help reduce complications during and after surgery.

Bowel Preparation and Diet

Bowel preparation clears the intestines, lowering infection risk and making surgery safer. Patients often follow a clear liquid diet for a day or two before the operation. Typical instructions include drinking only broth, tea, clear juices, and gelatin.

Doctors may prescribe a bowel cleansing agent, such as a laxative, to empty the bowels. Eating or drinking after midnight before surgery is usually not allowed. The team checks and corrects the patient’s hydration and electrolyte balance as needed.

Dietitians may give extra support if the patient has trouble eating or needs nutritional boosts in the days leading up to surgery. Written guidelines and checklists are sometimes provided.

Patient Education and Support

Patient education starts before admission and is led by an ostomy nurse or other trained staff. They show what the stoma and ileal conduit will look like using diagrams or models.

Patients learn how the pouching system works, including steps to change and empty it. Emotional support is important. The nurse may give information on local or online support groups where patients can talk with others who have gone through similar surgeries. Honest discussions about fears, body image changes, and recovery help ease anxiety.

Family involvement is encouraged for extra support. Printed resources and contact numbers for follow-up questions are provided. Open communication with the healthcare team helps the patient feel well-prepared and confident.

Surgical Technique for Ileal Conduit Creation

Surgeons commonly use the ileal conduit procedure to redirect urine after bladder removal. They use a segment of the small intestine to create a new passage for urine to exit the body and collect in an external bag.

Steps of the Surgical Procedure

The surgeon selects a 20 cm segment of the distal ileum, keeping at least 20 cm from the ileocecal valve. The surgeon separates this section from the rest of the bowel and stitches the ends of the remaining bowel back together so food can pass normally.

The surgeon carefully connects the ureters (tubes carrying urine from the kidneys) to the segment of ileum. Next, the surgeon brings one end of the ileal conduit through the abdominal wall to make a stoma. The stoma is the opening where urine will exit into a special urostomy bag worn on the skin.

The team cleans the area with antiseptic solutions to lower the risk of infection. The surgeon checks for leaks and ensures that urine flows freely from the kidneys, through the conduit, and out the stoma.

Open Surgery Versus Minimally Invasive Approaches

Open surgery is the traditional method for this procedure. The surgeon makes a larger incision in the lower abdomen to get a clear view of the area. Surgeons choose open techniques for complex cases and to allow hands-on access when connecting the bowel and ureters.

Minimally invasive surgery, such as laparoscopic or robotic approaches, uses smaller cuts and specialized tools. These methods often result in less blood loss and shorter recovery times but may not be right for everyone. Some patients with heavy scar tissue or other medical problems may still need open surgery. A table comparing the two:

Approach	Incision Size	Recovery Time
Open Surgery	Larger	Longer
Minimally Invasive	Smaller	Shorter

Anesthesia and Intraoperative Considerations

General anesthesia is required for the ileal conduit procedure. The anesthesia team keeps the patient asleep and pain-free while closely monitoring vital signs throughout surgery to maintain safety.

During surgery, the team places the patient on their back and maintains sterile conditions to reduce the chance of infection. They control blood loss and make sure the newly formed conduit is not twisted or kinked.

The team plans the stoma’s location before surgery, often marking the skin while the person is awake to support better healing and easier management of the urostomy bag after surgery. Proper positioning helps avoid leaks and skin problems later.

Post-Operative Care and Recovery

After ileal conduit surgery, hospital staff closely monitor patients. Medical staff checks vital signs, pain levels, and signs of infection. The hospital stay usually lasts about a week.

Some people may have a Jackson-Pratt (JP) drain to remove extra fluid from the abdomen. A small tube may also help urine drain from the new conduit. Medical staff usually removes both within two weeks. Typical post-operative care includes:

Watching for signs of infection (fever, redness, swelling)
Checking urine output and color
Keeping the surgical area clean and dry
Managing pain with medication

Patients may have some blood loss during surgery, but doctors monitor for any serious problems. Physical activity is limited at first. Nurses encourage patients to begin walking soon after surgery to prevent blood clots. Patients should avoid heavy lifting and hard exercise until the doctor says it is safe.

What to Watch For	What to Do
Fever or chills	Tell your doctor
Redness or swelling	Keep area clean, report concerns
Leaking from drains	Monitor and inform staff
Changes in urine output	Track daily and report changes

Doctors schedule several check-ups to make sure the conduit works and to support recovery. Staying in close contact with the healthcare team helps guide a safe return to daily activities.

Living With an Ileal Conduit

After an ileal conduit surgery, people will have a stoma on their abdomen. This is where urine leaves the body. A special urostomy bag or ostomy bag attaches over the stoma to collect urine. Emptying and changing the ostomy bag becomes part of everyday life. Most people find it helpful to develop a daily routine.

Bags are secure and can last for hours before needing to be emptied or replaced. Skin care is important. Patients should clean the area around the stoma gently with warm water and pat it dry. This helps prevent skin irritation and infection. If redness, soreness, or rash appears, consult a healthcare provider for advice.

Showering is safe and does not harm the stoma or the ostomy bag. Some people choose to shower with the bag off, while others keep it on. It is a personal choice. Having an ileal conduit may bring up feelings like worry or sadness. Many find it useful to join a support group for emotional support. Talking with others who have a urostomy can help with adjusting to the changes.

Tips for Daily Living

Empty the bag often to avoid leaks.
Carry extra supplies when leaving home.
Wear comfortable, loose clothing.
Ask for help from healthcare teams if problems arise.

Potential Complications of Ileal Conduit

Some people experience complications after an ileal conduit procedure. These issues may show up soon after surgery or much later. Infections are a common risk. This includes urinary tract infections (UTIs), which can happen because the urine passes through the conduit.

Stoma infections can also occur at the site where the conduit meets the skin. People may also have problems with bowel function. These include prolonged ileus (when the bowels move slowly after surgery) and bowel obstruction. Obstructions can block the movement of food or waste, sometimes needing more treatment.

Stoma complications are also possible. Stenosis, or narrowing of the stoma, may make urine output more difficult. Other issues include stoma retraction, where the stoma pulls back into the abdomen, or prolapse, where the stoma sticks out further than normal.

Peristomal skin irritation can develop due to contact with urine or the stoma appliance, causing redness, pain, or sores. Some people may develop a hernia near the stoma. This happens when part of the intestine pushes through weak abdominal muscles, forming a bulge.

Table: Potential Complications

Complication	Description
Infection/UTI	Urinary tract or stoma site infection.
Ileus/Obstruction	Slow or blocked bowel movement.
Stenosis	Narrowing of the stoma opening.
Stoma Retraction/Prolapse	Stoma pulls back or protrudes excessively.
Peristomal Skin Irritation	Redness, soreness, or sores around stoma.
Hernia	Bulge near stoma from weak abdominal muscles.

Bladder Function and Alternatives

The bladder normally stores urine until a person is ready to urinate. After an ileal conduit procedure, surgeons remove or bypass the bladder. Urine then exits the body in a different way. Two main types of urinary diversion exist: incontinent and continent.

Incontinent Urinary diversion

The most common type is the ileal conduit.
Urine flows into an external bag attached to the abdomen.
The person does not control when urine leaves their body.

Continent Urinary Diversion

These options allow for some control over urination.
Surgeons use a piece of intestine to create a neobladder, connecting it directly to the urethra.
The Indiana pouch forms a pouch inside the body, which the person empties with a catheter.

Diversion Type	Storage Location	Control Over Urination	External Bag Needed
Ileal Conduit	Small intestine	No	Yes
Neobladder	Constructed bladder	Yes	No
Indiana Pouch	Pouch from bowel	Yes	No (uses catheter)