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>> Sometimes bladder cancer management involves radical surgery, in other words,
removing the bladder and that's called a cystectomy and when we remove the bladder,
we have to piece the urinary system back together in a way that will either store urine
in the body or make it easier to get rid of the urine.
There's three general ways we can do that; two of them are internalized
or on the inside, for the most part.
One is functionally on the outside in that there's a bag,
sitting on top of the abdominal wall so people view that as being on the outside;
that one is terms an ileal conduit and it's actually the most common type
of diversion that's performed, probably in 50 to 60% of patients.
That type of diversion involves taking a small piece of the intestine, the small intestine
in fact, most of the time it's going to be the ileum and so you'll hear the term ileal conduit
and we take the ureter tubes that drain urine from the kidneys and we plug it into that piece
of bowel and we bring it through the abdominal wall.
Then urine will drain from the kidneys down those ureter tubes,
out that piece of intestine, outside of your body into a bag.
Another type of diversion is called the neo bladder and although it seems
like a new bladder, it's not exactly the same as the one that you were born with.
What we do to create that type of diversion is to take small intestine and we use probably
about four times as much as would use for the ileal conduit and we create a storage chamber
in the lower belly and we connect it to the place where the old bladder used to be,
that's called the urethra; that allows someone to urinate from the storage chamber
through the urethra and then evacuating urine, as you would naturally.
So that type of diversion, the neo bladder,
is really the most natural that we can offer patients.
The third type of urinary diversion is the colon pouch and that one uses the right colon,
the large intestine and creates a pouch.
From that pouch, a piece of small intestine comes through the belly wall
and someone can use a small catheter to pass it from the outside of the body through that piece
of intestine into that pouch to drain it.