Urinary diversion surgery is a critical procedure for individuals dealing with severe bladder issues, such as cancer, injury, or congenital conditions. This surgery is designed to reroute urine from the kidneys to an external pouch or an internal reservoir when the bladder can no longer function effectively. When discussing urinary diversion, two primary types arise: continent and incontinent urinary diversion. Understanding the differences between these two procedures is crucial for patients considering surgical options.

Continent Urinary Diversion

Continent urinary diversion is a surgical technique that allows the patient to maintain some degree of control over urination. This procedure involves creating a new reservoir from a segment of the intestine that can store urine without the need for an external collection device.

One of the most common forms of continent urinary diversion is the Indiana pouch. In this method, part of the intestine is fashioned into a pouch, which collects urine. The pouch is then connected to the ureters, allowing urine to flow from the kidneys. Importantly, a catheterization process is required, where the patient inserts a catheter into a stoma (an opening created surgically) to drain the pouch at intervals of their choosing, thus allowing for planned urination.

Benefits of continent urinary diversion include:

• Maintaining control over urination, which can enhance the patient’s quality of life.
• No need for external appliances or bags, leading to a more natural appearance.
• Reduced risk of skin irritation often associated with external catheter systems.

Incontinent Urinary Diversion

In contrast, incontinent urinary diversion involves the creation of a urinary diversion system that does not allow for voluntary control of urination. Patients with this type of diversion typically use external appliances to collect urine.

The most well-known type of incontinent urinary diversion is the ileal conduit. In this procedure, a small piece of the intestine is detached and re-routed to form a conduit that carries urine from the kidneys to an external stoma. The urine continuously drains into a collection bag worn outside the body, as the patient does not have the ability to control when urination occurs.

Some key points regarding incontinent urinary diversion include:

• Simplicity of surgical procedure compared to continent options, making it a viable choice for a broader range of patients.
• Immediate urine drainage, which can be beneficial for those unable to perform self-catheterization.
• However, it requires the use of external bags, which may lead to discomfort or limitations in lifestyle.

Key Differences

When comparing continent and incontinent urinary diversion, several factors come into play:

• Control: Continent diversions allow for control of urination through catheterization, while incontinent diversions require constant use of external bags for urine collection.
• Aesthetic Appeal: Continent options maintain a closer semblance to normal urinary function, whereas incontinent diversions are more visible due to external appliance usage.
• Postoperative Management: Patients with continent diversions need to learn a regimen of catheterization, while incontinent diversion management revolves around caring for the collection bag.

Deciding between continent and incontinent urinary diversion ultimately depends on individual circumstances, including the underlying medical condition, personal preference, lifestyle, and overall health. Patients are encouraged to discuss thoroughly with their healthcare providers to determine the most appropriate option tailored to their needs.