Urinary Diversion

Access exceptional care for urinary diversion procedures at Montefiore Einstein Urology. As a leader in urology, we are an academic-based referral site for the most complex and high-risk cases. For over a century, we have been at the forefront of innovation, research and clinical care for genitourinary (GU) conditions.

Ranked in the top 1% of all hospitals in the nation for urology according to U.S. News & World Report, Montefiore Einstein continues to make advances in the diagnosis and treatment of GU conditions. Our multidisciplinary team of specialists is passionate about uncovering the latest diagnostic approaches and treatments that can improve outcomes.

Montefiore Einstein Urology offers you compassionate, personalized, research-driven treatment plans that meet the highest standards for quality and safety. In addition, we offer patients a full range of support services, from nutritional guidance to rehabilitative therapies. Our specialists are leaders in minimally invasive, laparoscopic, and robotic surgery. We performed the region’s first robotic bladder augmentation and continent urinary diversion procedure.

When you need urinary diversion care, turn to our dedicated providers who will develop a highly personalized treatment plan.

The most common reason you might need a urinary diversion is bladder cancer that requires the bladder to be removed, a procedure called a cystectomy. Other reasons for a urinary diversion include:

• Chronic or long-lasting inflammation of the bladder, which may result from severe cases of interstitial cystitis, recurrent urinary tract infections or chronic urinary retention
• Chronic urinary retention from an enlarged prostate or benign prostatic hyperplasia 
• Conditions that cause outside pressure to the urethra or one or both ureters
• Nerve damage to the bladder caused by birth defects such as spina bifida, spinal cord injury or multiple sclerosis
• Radiation therapy that results in permanent damage to the bladder
• Severe urinary incontinence that can’t be managed with standard treatments
• Trauma to the bladder, urethra or pelvis
• Tumors in the genitourinary tract or adjacent tissues and organs
• Urinary stones

The main types of urinary diversion include:

Bladder catheterization: Bladder catheterization involves inserting a catheter (a thin, flexible tube) into the bladder to drain urine. The urine drains into a collection bag outside the body. The two types of urinary catheters include:

• Foley catheter: inserted into the bladder through the urethra
• Suprapubic catheter: inserted into the bladder through a small hole in the skin beneath the belly button

Urinary catheters may remain in place for several days or weeks while tissues heal after urinary tract surgery or treatment of urinary blockage, or, in some cases, they may be permanent. Catheters that are in place for longer periods of time need to be replaced with a new catheter periodically.

Cystostomy: A cystostomy is a surgical procedure in which a doctor inserts a small tube into your bladder through the skin of the lower abdomen. The tube allows urine to drain from your bladder into a bag outside your body.

Nephrostomy: Similar to a cystostomy, during a nephrostomy, a surgeon or radiologist makes a tiny incision and inserts a small tube, called a nephrostomy tube, through the skin of your back into your kidney. The nephrostomy tube allows urine to drain from your kidney into a bag outside your body.

You may need a nephrostomy when being treated for a kidney stone or when your ureters are narrowed, blocked or inflamed. Depending on the reason for the nephrostomy and how quickly your body heals, the nephrostomy tube may be used for different lengths of time.

Ureteral stent: A ureteral stent is a thin, flexible tube that is inserted into the ureter to help urine flow from the kidney to the bladder. The ureteral stent is guided with a cystoscope into your ureter, then one end of the stent is placed in the kidney, and the other end is placed in the bladder.

You may need a ureteral stent if one of your ureters is blocked as a result of surgery, a kidney stone, a tumor or infection. A ureteral stent is usually temporary but, in some cases, can be used to permanently manage a blockage of the ureter. Ureteral stents that are in place for longer periods of time need to be replaced periodically.

Urostomy: A urostomy is a stoma, or opening, in your abdomen that connects to your urinary tract to allow urine to drain freely from your body. Urine is collected and stored in a small bag, called a urostomy pouch, which you can empty at your convenience. The pouch is attached to the skin around your stoma and worn outside your body. The two main types of urostomy include: 

• Cutaneous ureterostomy: A surgeon attaches one or both ureters directly to a stoma in your abdomen.
• Ileal conduit: A surgeon removes a piece of your intestine to create a passageway for urine. The ureters are attached to the piece of intestine, which is then attached to an opening in your abdomen, creating a stoma. The urine flows from the ureters, through the piece of intestine and out the stoma.

Continent urinary diversion: Continent urinary diversion collects and stores urine inside the body until you drain the urine using a catheter or you urinate through the urethra. The urine flows through the ureters and is stored in an internal pouch created from part of your bowel or in your bladder. Continent urinary diversion allows you to control when urine leaves your body. The main types of continent urinary diversion include:

• Continent cutaneous reservoir: A surgeon uses a piece of your bowel to create an internal pouch, or reservoir, to hold urine. The internal pouch is placed inside your abdomen. The ureters are attached to the internal pouch, and the internal pouch is attached to a stoma in your abdomen. Urine flows through the ureters and into the internal pouch, where it is stored until you drain the urine by inserting a catheter into the stoma. The stoma is the end of a channel that connects to the reservoir. The channel has a valve that prevents urine from exiting the body until a catheter is inserted. The channel can be created from a piece of intestine or by using the appendix.
• Bladder substitute or neobladder: A surgeon uses a piece of your bowel to create an internal reservoir, called a bladder substitute or neobladder, to hold urine. The bladder substitute is placed in the pelvis. The ureters are attached to the bladder substitute, and the bladder substitute is attached to the urethra. Urine flows through the ureters into the bladder substitute, and you urinate through the urethra.

The type of urinary diversion procedure you have will depend on different factors, including your age, prior medical history, previous surgeries, how well you can move around, if you’ve had radiation therapy or cancer, your ability to use a catheter and your preference.