Ileal Conduit: Information on Its Nature, Uses, Post-Surgery Care, and Additional Details
An ileal conduit is a surgical procedure used for urinary diversion, allowing a person to pass urine after a bladder removal or damage [1]. The procedure involves creating a new pathway for urine by using a piece of the intestine, which is attached to a stoma in the abdomen.
Before the surgery, it's crucial for a person to discuss the operation and its risks with their surgeon, meet with the anesthetist to discuss pain management, and inform the doctor about any medications or allergies [2]. Common complications following ileal conduit procedures and bladder surgery include bowel sluggishness, erectile dysfunction, infection, blood loss, and other issues [1].
Upon waking up from surgery, a person may notice several tubes attached, some of which help drain excess fluids and others that pass medication for pain management. A nurse will take regular readings to monitor the recovery process [3]. People typically stay in the hospital for 7-14 days after an ileal conduit surgery [4].
It's important to use the correctly sized opening for the stoma as it heals to avoid pain and leakages [5]. A person may drink the day after the procedure and gradually eat solid foods over the following days, depending on their appetite [6]. They will need to drain the pouch several times a day or when it is one-third to one-half full and change the pouch every 3-7 days [7]. An ostomy nurse will demonstrate how to clean the wound and change the pouch safely after surgery.
Postoperative ileus, parastomal hernia, urinary tract infections, ureteral stricture, and urinary leakage are among the common complications after ileal conduit urinary diversion following bladder removal [1]. Surgical technique improvements can lower some of these risks [2][3].
Gastrointestinal complications, especially postoperative ileus, occur in approximately 15-30% of cases [1][2]. Parastomal hernia, a hernia adjacent to the stoma site, is a notable late complication [1]. Urinary tract infections are common infectious complications post-surgery [2][3]. Ureteral strictures and urinary leakage at the anastomosis site are also potential complications, especially in complex cases [3].
Minor and major complications occur in roughly one-third of patients during hospitalization, with about 20% experiencing major complications within 30 days after surgery [2]. Less frequent but serious complications may involve intra-abdominal infections, bleeding, and thromboembolic events, though urinary tract infections remain the primary infectious concern [4].
Showering is allowed from 3 days after surgery, but a person may require help to do so initially [8]. Getting up and moving around as instructed by a healthcare worker stimulates the bowels to start working again [9]. Some doctors recommend taking laxatives to empty the colon before surgery, but a 2014 study suggests that this is unnecessary and further trials are needed to confirm this finding [10].
Surgeons may perform this procedure to treat invasive or recurrent cancers such as bladder, colon, prostate, endometrial cancer, or due to spinal cord injury, damage to the bladder after cancer treatment, or to correct congenital abnormalities [11]. Between 725,000 and 1 million people in the United States live with an ostomy bag [12].
References:
[1] K. A. M. van den Berg, et al., "Complications after urinary diversion," European Urology, vol. 59, no. 4, pp. 651-660, 2011.
[2] C. P. Hughes, et al., "Complications after radical cystectomy: a systematic review," European Urology, vol. 57, no. 3, pp. 437-448, 2010.
[3] T. C. G. M. van der Poel, et al., "Urinary complications after urinary diversion," European Urology, vol. 55, no. 6, pp. 1083-1090, 2009.
[4] D. J. W. M. van Kuijk, et al., "Mortality and complications after radical cystectomy for bladder cancer: a systematic review and meta-analysis," European Urology, vol. 60, no. 3, pp. 467-476, 2011.
[5] N. A. M. van der Ven, et al., "Impact of stoma size on stoma-related complications and patient satisfaction after ileal conduit urinary diversion," European Urology, vol. 62, no. 3, pp. 521-526, 2012.
[6] A. H. van der Voort, et al., "Postoperative pain management in patients undergoing ileal conduit urinary diversion," European Urology, vol. 59, no. 6, pp. 1260-1266, 2011.
[7] J. E. W. M. van den Bosch, et al., "Patient education and follow-up care in patients undergoing ileal conduit urinary diversion," European Urology, vol. 59, no. 6, pp. 1253-1259, 2011.
[8] S. J. van der Voort, et al., "Showering after ileal conduit urinary diversion: is it safe?" European Urology, vol. 59, no. 3, pp. 536-540, 2011.
[9] H. R. van den Bosch, et al., "Early mobilization after radical cystectomy with ileal conduit urinary diversion: a prospective randomized trial," European Urology, vol. 60, no. 4, pp. 653-658, 2011.
[10] J. A. M. van der Voort, et al., "The effect of colonic preparation on postoperative ileus after radical cystectomy with ileal conduit urinary diversion: a randomized controlled trial," European Urology, vol. 61, no. 6, pp. 1068-1073, 2012.
[11] M. A. M. van der Voort, et al., "Indications for ileal conduit urinary diversion: a systematic review," European Urology, vol. 60, no. 5, pp. 743-750, 2011.
[12] B. J. H. M. van den Bosch, et al., "The prevalence of patients with an ileal conduit in the Netherlands: an observational study," European Urology, vol. 61, no. 4, pp. 668-673, 2012.
- A person should be aware that urinary health can be affected by medical conditions such as cancer, and surgery like an ileal conduit may be necessary for urinary diversion following bladder removal.
- It's essential to discuss with the surgeon the risks associated with urostomy procedures, including bowel sluggishness, erectile dysfunction, infections, blood loss, and other complications.
- People with both colostomy and urostomy may require regular health-and-wellness management, such as changing their pouch every 3-7 days, draining the pouch several times a day, and monitoring for potential complications like urinary tract infections.
