Reconstructive Surgery
If you have a cystectomy, you also will have reconstructive surgery. Once the bladder is removed, it is necessary to create a storage space to take over the bladder functions, and to fashion a structure that will allow you to pass urine. This may be done 3 different ways.
Urostomy
The most common method to make a passageway for urine is by the formation of an ileal conduit or urostomy. This method is used when the urethra is removed as part of the cystectomy. For this procedure, the surgeon uses a portion of the small intestine (the ileum) to make a tube through which urine will pass out of the body through an opening on the outside of the body. The opening is called a stoma. The stoma is shiny, wet, and red in color, like the inside of the mouth. It is round to oval in shape and usually placed above the groin on the right side of the abdomen. People who have a urostomy wear a flat, disposable, and watertight bag to collect urine. The bag must be emptied and replaced regularly, and the stoma cleaned and checked.
Continent Reservoir
Depending on your anatomy, your doctor may use part of your small intestine to create a storage pouch called a continent reservoir inside your body to collect urine. This pouch can also be called an Indiana pouch. Unlike the ileal conduit, you will not have to wear an external bag. The stoma is very small and can be covered with a bandage. Inside the pouch is a one-way valve that does not allow urine to escape. Every 4 to 6 hours, you will insert a small catheter (tube) into the stoma. This will open the valve and allow the urine that was in the pouch to drain out through the catheter. The catheters can be used many times but remember to wash it with soap and water after each use and store in a protective pouch, such as a Ziploc bag.
Orthotopic Neobladder
If the biopsy of your urethra showed no cancer, a part of your small intestine can be used to make a new pouch (a neobladder) that is connected directly to your urethra. No stoma is created, and so there is no need for an external bag to collect urine or to insert a small catheter every 4 to 6 hours. Instead, the neobladder empties just as the original bladder did, with urine passing normally, through the urethra. Some people may need to use a small disposable catheter a few times a day to empty the neobladder. The catheter, however, will be placed into the bladder through the urethra. Unlike the ileal conduit and continent reservoir, there will be no stoma.
