Ileal conduit 

Ureters 

Stoma 

Urostomy and Continent 

Urinary Diversion 

National Kidney and Urologic Diseases Information Clearinghouse 

National 

Institute of 

Diabetes and 

Digestive 

and Kidney 

Diseases 

NATIONAL 

INSTITUTES 

OF HEALTH 

U.S. Department 

of Health and 

Human Services 

Your kidneys filter waste and excess fluid 

from your blood, making urine. The urine 

then travels from the kidneys to the bladder 

through tubes called ureters. The bladder 

stores urine until you have the sensation to 

void. If your bladder is injured or diseased, 

you may not be able to urinate in the normal way. 

A urinary diversion is a way to release urine 

from the body when you can’t urinate 

because the urinary system is damaged or 

not working. You will need a urinary diversion, for example, if your bladder has been 

removed to stop the spread of cancer, or if 

your bladder has nerve damage. Any problem in the bladder that blocks the flow of 

urine and causes it to accumulate in the 

ureters and kidneys may result in the need 

for a urinary diversion. 

A urinary diversion may mean a urostomy, 

which requires a pouch to be worn outside 

the body, or a continent diversion, which 

involves the creation of a pouch or bladder 

inside the body, usually using part of the 

digestive tract. 

The ileal conduit is made from a short segment of the 

small intestine. The ureters are attached to one end of 

the conduit. The other end is placed at the skin’s 

surface to create a stoma. 

Urostomy 

A surgeon creates a urostomy by redirecting your urine to an opening created in the 

abdomen. The opening is called a stoma. 

Two main types of urostomy are available. 

A stoma is an opening in the abdomen used for 

releasing urine from the body. 

•	 Ileal conduit. To create an ileal conduit, the surgeon takes a short 

segment of the small intestine and 

reconnects the remaining intestine so 

that it functions normally. One end of 

the removed short segment of intes-
tine is placed at the skin surface to create the stoma. The ureters, which normally carry urine from the kidneys to 

the bladder, are then attached to the 

other end of the segment of intestine. 

The urine travels through the newly 

formed ileal conduit and the stoma 

into an external collecting pouch. The 

pouch has an outlet for releasing urine 

into a toilet without removing it from 

your stoma. 

•	 Ureterostomy. Very rarely, the surgeon connects the ureters directly to 

the abdominal wall to create a stoma. 

Like the ileal conduit, a ureterostomy 

requires a collecting pouch placed 

over the stoma because there are no 

muscles around the stoma to control 

the flow of urine. 

Stoma Stoma 

In a ureterostomy, the ureters are connected directly to 

the abdominal wall to create two stomas. 

Internal 

pouch Stoma 

With a continent cutaneous reservoir, an internal pouch 

stores urine. The patient uses a catheter or plastic tube 

to empty urine through the stoma. 

Continent Diversion 

Another method of storing and eliminating 

urine is the continent diversion. In this 

method, the surgeon creates a pouch, or 

reservoir, inside your body from a section 

of your stomach or small or large intestine. 

The ureters carry urine to the pouch, where 

it is stored. Depending on the type of continent diversion, you may or may not have 

a stoma. 

•	 Continent cutaneous reservoir. 

This form of continent diversion does 

include a stoma. This method requires 

you to empty the reservoir, the internal pouch, regularly through the stoma 

using a catheter or thin plastic tube. 

If your urethra is preserved during the 

operation, you may be able to have a 

2 Urostomy and Continent Urinary Diversion 
Bladder 

substitute 

Urethra 

With a bladder substitute, the patient can urinate 

through the urethra. 

urinary diversion that does not require 

a stoma or catheter. 

•	 Bladder substitute. This method lets 

you urinate through your own urethra 

as you did with your original bladder, 

or you may have to empty using a 

catheter through your urethra. The 

surgeon creates an internal pouch 

that stores urine as your bladder did. 

It is connected to your urethra so you 

may be able to empty your bladder in 

the normal way, although you will 

need to use different muscles to expel 

the urine. 

Caring for Your Urinary 

Diversion 

After your surgery, a wound, ostomy, and 

continence (WOC) nurse can work with 

you to help you learn how to take care of 

your urinary diversion. WOC nurses are 

experienced and knowledgeable, so don’t 

be shy about asking questions if you have 

any concerns. 

Changing Pouches 

If you have an ileal conduit or ureterostomy, you will work with your doctor or 

WOC nurse to learn how to change your 

pouch. Your pouching system may consist 

of two pieces—a barrier that sticks to your 

skin and a pouch that attaches to the barrier. In some systems, the barrier and pouch 

are a single unit. 

A two-piece pouch system. The square barrier sticks to 

the skin. The pouch attaches to the barrier. 

3 Urostomy and Continent Urinary Diversion 
Using a Catheter 

If you have a continent reservoir, you will 

learn how to insert a catheter through the 

stoma or your urethra to drain your reservoir. You may do this either by standing in 

front of the toilet or by sitting on the toilet 

and then emptying the catheter between 

your legs. In the first few weeks, you will 

need to use the catheter every couple of 

hours. Soon, you will be able to go 4 to 6 

hours between catheterizations. Wash 

your hands with soap and water each time 

you use a catheter. 

Cleaning 

If you use a pouch, you can clean your skin 

with a wet towelette or washcloth as you 

change the pouch. Let your skin dry completely before you apply the new pouch. 

If your skin becomes irritated, you can 

use protective skin wipes or an ostomy 

powder designed to protect the skin around 

a stoma. 

If you have a continent diversion, you will 

need to irrigate, or flush out, the reservoir 

using sterile water or normal saline and a 

syringe. Since the reservoir may be made 

from a part of the intestine, it may produce 

mucus that normally lines the digestive 

tract. Irrigating or flushing the reservoir 

clears this mucus from the reservoir. Talk 

with your health care provider about how 

often you should irrigate the reservoir. 

Recognizing Infection 

Urostomies and continent urinary diversions can get infected. Symptoms of infection include 

•	 dark urine or urine containing excess 

mucus 

•	 strong-smelling urine 

•	 pain in the back 

•	 poor appetite 

•	 nausea 

•	 vomiting 

Call your health care provider if you notice 

any of these warning signs. Drinking eight 

full glasses of water every day can help prevent infection by flushing out bacteria. 

Diet 

You probably will be able to eat your normal diet. You may find that some foods, 

such as asparagus and seafood, cause 

urine to have a stronger odor. Talk with 

your health care provider about your 

dietary needs. 

Clothing 

Wearing a urostomy pouch does not 

require special clothing. Modern pouches 

are designed to lie flat against the body so 

they can’t be noticed. You may wear the 

pouch tucked inside your underwear or 

between your underwear and your outer 

clothing. Women may wear a pouch under 

a girdle as long as it is made of stretchy 

material. Men may wear the pouch inside 

an athletic supporter. 

4 Urostomy and Continent Urinary Diversion 
Activities 

You will need to restrict your activity 

during the first 2 to 3 weeks after surgery. 

Avoid driving and heavy lifting to help 

your stoma heal. Once healed, you 

should be able do most of the activities 

you enjoyed before your surgery. The only 

exceptions may be contact sports like football or karate. If your job includes hard 

physical labor, talk with your doctor and 

your employer about making adjustments 

to your job responsibilities. 

Relationships 

You may worry that people will have negative reactions regarding your surgery. Most 

people will never know that you are wearing a pouch, unless you choose to tell them. 

Friends and relatives are likely to be aware 

of your health problems, but only a spouse, 

intimate partner, or primary care taker 

need know the details of your urinary diversion surgery. Still, many people find being 

open about their situation is easier than 

keeping it a secret. You can choose how 

much you will share about your condition. 

You can still maintain a satisfying sexual 

relationship with your partner. Your doctor 

or WOC nurse will tell you when you may 

safely resume sexual activity after your surgery. Talk with your health care provider 

about any concerns you have with maintaining intimate relations. Your nurse or doctor can give you information about ways to 

protect your stoma during sex. You may 

also want to ask about specially designed 

apparel to enhance intimacy for people 

with ostomies. Communicating with your 

partner is essential. Share your concerns 

and wishes, and listen carefully to your 

partner’s concerns. 

Hope Through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK) 

has many research programs aimed at finding and improving treatments for urinary 

disorders. Researchers supported by the 

NIDDK are working to understand the 

growth of bladder tissue in order to find 

artificial methods of generating that kind 

of tissue. In an experimental setting, a 

patient whose bladder must be removed 

may be given a replacement bladder made 

from bioengineered tissues instead of from 

a segment of the patient’s bowel. The bioengineered tissue would function much 

more like a natural bladder. 

For More Information 

American Urological Association, Inc. 

1000 Corporate Boulevard 

Linthicum, MD 21090 

Phone: 1–800–RING–AUA (746–4282) 

or 410–689–3700 

Email: aua@auanet.org 

Internet: www.urologyhealth.org 

Wound, Ostomy & Continence 

Nurses Society 

4700 W. Lake Avenue 

Glenview, IL 60025–1485 

Phone: 1–888–224–9626 

Email: info@wocn.org 

Internet: www.wocn.org 

5 Urostomy and Continent Urinary Diversion 
National Kidney and 

Urologic Diseases 

Information Clearinghouse 

3 Information Way 

Bethesda, MD 20892–3580 

Phone: 1–800–891–5390 

Fax: 703–738–4929 

Email: nkudic@info.niddk.nih.gov 

Internet: www.kidney.niddk.nih.gov 

The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of 

the National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The NIDDK is 

part of the National Institutes of Health under the 

U.S. Department of Health and Human Services. 

Established in 1987, the Clearinghouse provides 

information about diseases of the kidneys and urologic system to people with kidney and urologic 

disorders and to their families, health care professionals, and the public. The NKUDIC answers 

inquiries, develops and distributes publications, 

and works closely with professional and patient 

organizations and Government agencies to coordinate resources about kidney and urologic diseases. 

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists and 

outside experts. This publication was reviewed by 

Susan Appleby, WOCN, Banner Home Care; and 

Anthony Atala, M.D., Wake Forest University. 

This publication is not copyrighted. The 

Clearinghouse encourages users of this fact 

sheet to duplicate and distribute as many 

copies as desired. 

This fact sheet is also available at 

www.kidney.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 06–5629 

May 2006