February 2009
Page 6
Urinary Diversions or What Does One Do Without a Bladder?
Basically, the bladder is a hollow muscle which performs two important functions. It acts as a storage device for the accumulating urine, relaxing as the volume increases. But it also acts as a pump as it contracts, squeezing out the urine through the urethra to the outside of the body. Accident or illness may dictate the removal of the bladder, thus necessitating the introduction of alternate methods or devices to dispose of the urine. Such devices (or substitute bladders) should provide the following: A low pressure system to assure continence and prevent damage to the kidneys. Be continent, preventing leakage and associated physical and social problems. Be non-flexing, thus preventing recirculation of urine to the kidneys. Be easily emptied. Should avoid certain metabolic/electrolyte salt chemistry problems that configurations of intestines can impart.
Prior to 1950, the removal of a damaged or diseased bladder allowed relative few alternatives. One procedure brought the ureter out to the skin individually. Since the ureters are very small in diameter, often no larger than the thickness of the lead of a pencil, problems with narrowing of the ducts, even occlusion, as well as infections were frequent occurrences. Furthermore, the employment of appliances to collect the urine was difficult and generally inefficient. In 1950, the ileal conduit was devised by a Dr. Bricker in a procedure which attached the two ureters to a section of the small intestine and then brought the intestine out through the abdominal wall into a stoma. The procedure had the advantage of assuring unimpeded flow of urine through the stoma as well as the more effective and practical use of an appliance to collect the urine. Bricker's ileal conduit has remained a favorite procedure throughout the years, even though it is still subject to infection and reflux to the kidneys and requires that a prosthesis be worn at all times.
SOURCE: Metro Halifax & Lee County, FL: The Re-Route on-line, Evansville, IN December 2008, via Inside Out On-line Feb 2009.
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