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Urinary diversion: the three options after your bladder is removed | CION Cancer Clinics
When the bladder is removed, the surgeon builds a new route for urine during the same operation. There are three: an ileal conduit that drains into a bag on the belly, a neobladder joined to the urethra so you pass urine the usual way, and a continent pouch you empty with a thin tube. This page explains each one, how the choice is made, and what it cannot tell you. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What are the options for passing urine after the bladder is removed?
- What each one looks like in daily life
- Conduit and neobladder, compared on what matters at home
- What happens between the diagnosis and the decision
- The words you will see, in plain language
- Four things families tell us, and what is actually true
- What this page cannot tell you
- Common questions about urinary diversion
The short answer
What are the options for passing urine after the bladder is removed?
There are three. An ileal conduit, where urine drains through a small opening on the belly into a bag. A neobladder, where a pouch made of bowel is joined to the urethra so you pass urine the usual way. And a continent pouch, where a bowel reservoir sits inside and you empty it with a thin tube. Every one of them uses a piece of your own bowel.
Why a diversion is needed at all
The kidneys keep making urine whether or not there is a bladder to hold it. The two tubes from the kidneys, called the ureters, need somewhere to drain. The diversion is the new route the surgeon builds for that urine, during the same operation.
Who decides which one
You and your surgical team, together, before the day. The choice depends on where the cancer sits, how your kidneys are working, whether you can manage a tube or a bag, and what you want daily life to look like. No option is right for everyone, and this page does not tell you which one is right for you.
If your surgeon has already named one option, ask why the other two were set aside.The three options
What each one looks like in daily life
The surgery differs less than the life afterwards does. Read these with the person who will be helping at home.
Ileal conduit
A short piece of small bowel carries urine from the kidneys to an opening on the belly, called a stoma. A bag sticks to the skin over it and fills steadily. You empty it several times a day and change it every few days.
Suits people who want
- The simplest operation and recovery
- No new way of passing urine to learn
Neobladder
A longer piece of bowel is shaped into a pouch and joined to the urethra, the tube you already pass urine through. No bag, no stoma. You learn to empty it by relaxing the pelvic floor and pressing on the belly, by the clock rather than on an urge.
Suits people who want
- Nothing visible on the skin
- And can commit to months of retraining
Continent cutaneous pouch
A bowel reservoir sits inside the belly with a small, flat opening on the skin. It does not leak, so no bag is worn. You pass a thin tube through the opening every few hours to drain it. The Indiana pouch is the common version.
Suits people who want
- No bag, when a neobladder is not possible
- And have steady hands and good eyesight
Not sure whether this applies to you?
Ask an oncologistSide by side
Conduit and neobladder, compared on what matters at home
Ileal conduit
Neobladder
A bag on the belly, changed every few days
No bag; urine passed the usual way
Shorter operation and a simpler recovery
Longer operation and a longer learning period
Works from day one without training
Needs months of timed emptying and pelvic floor work
Night leakage is not a problem, the bag collects it
Night leakage is common in the first year, sometimes longer
Possible for almost everyone fit for a cystectomy
Not possible if cancer is near the urethra or the kidneys are weak
How the choice is made
What happens between the diagnosis and the decision
The cancer is mapped
The scans and the biopsy show where the tumour sits. If it reaches the bladder neck or the urethra, the urethra may have to be removed too, and a neobladder is then off the table.
Your kidneys and bowel are checked
Blood tests measure how well the kidneys clear waste. A pouch made of bowel reabsorbs some of what it holds, so weak kidneys push the team towards a conduit. Previous bowel disease or bowel surgery also matters.
Your daily life is talked through
Eyesight, hand strength, memory, who lives with you, whether you travel for work, how you sleep. A stoma nurse usually joins this conversation and can show you the actual bag and the actual tube.
A first choice and a fallback are agreed
The surgeon writes down the plan and a second option, because the final call can change during the operation if tissue at the urethra turns out to contain cancer. You will be told in advance if that is likely.
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On your report
The words you will see, in plain language
- Urinary diversion
- Any of the three ways of re-routing urine once the bladder has been removed. Your discharge summary will name which one you had.
- Stoma
- The opening on the belly where the bowel is brought to the skin. It is pink, moist and has no feeling, so it does not hurt to touch.
- Urostomy
- A stoma that carries urine. It is the everyday name for an ileal conduit and its bag.
- Ureter
- One of the two tubes carrying urine from each kidney. Both are joined to the new conduit or pouch during the operation.
- Self-catheterisation
- Passing a thin, single-use tube to drain urine yourself. Needed with a continent pouch and sometimes with a neobladder.
Commonly believed
Four things families tell us, and what is actually true
"The neobladder is the modern option, the bag is
old-fashioned."
All three are current operations done by the same surgeons. The conduit remains the most common diversion worldwide because it is dependable and easy to live with for many people. Newer is not the same as better for you.
"With a bag, he will never leave the house again."
People with urostomies work, farm, travel, swim and wear sarees and formal shirts. Modern bags sit flat, do not smell when sealed, and are changed in minutes. Most of the fear comes from never having seen one.
"A neobladder works just like the old bladder."
It does not. A bowel pouch has no nerves to tell you it is full, so you empty it by the clock. Leaking at night is common for months. Many people are very happy with it, but only after the retraining.
"We can decide about the diversion after the
operation."
The diversion is built during the same operation as the bladder removal, so the decision comes before it. Changing from one to another later is a second major operation and is rarely done. Take the time now.
Being straight with you
What this page cannot tell you
It cannot tell you which diversion you should have. That depends on the position of your tumour, your kidney results, your bowel history, and what you can manage at home. Only your own surgical team, with your reports in front of them, can weigh all of that.
It cannot tell you how well you will recover
Recovery is measured in weeks for the wound and in months for the diversion. How quickly that goes depends on your age, your fitness before surgery, and how the bowel settles.
It cannot tell you what it will cost
The operation, the stay and the supplies afterwards vary with the diversion chosen and with your cover. Aarogyasri, CGHS, ECHS, EHS and cashless insurance each treat the ongoing supplies differently. Ask for a written estimate against your own scheme before you decide.
What to do next
Ask your surgeon which of the three are possible in your case, and why. Ask to meet the stoma nurse before the operation. And bring the family member who will be at home with you, because they are choosing too.
Unsure what you have been told? Call the helpline and someone will go through the letter with you.Questions we are asked
Common questions about urinary diversion
Can I choose whichever diversion I want?
You can state a preference, and it carries real weight. But the position of the cancer, your kidney results and your bowel history can rule an option out. A surgeon who says a neobladder is not possible is usually describing a finding on your scan or blood test. Ask which.
Is one of the three safer than the others?
The bladder removal itself carries the same risks whichever diversion follows. The conduit is the shorter and simpler addition. Pouches need more bowel and more joins, which adds some risk of leaks and of the pouch needing attention later. Ask your team for the figures that apply to you.
Will the bag or the pouch be visible under clothes?
A urostomy bag sits below the waistline and is flat when emptied. Under a saree, a kurta or a loose shirt it is not seen. A continent pouch has a small opening covered with a plaster. A neobladder has nothing on the skin except the scar.
Can a woman have a neobladder?
Yes. It is done less often in women than in men, partly because the urethra is shorter and partly because emptying difficulties are more common afterwards. Whether it is possible depends on where the cancer sits and on your team's experience. Ask directly.
Does the piece of bowel that is used cause problems?
Usually not for bowel movements, because only a short length is borrowed. Bowel lining absorbs what touches it, so some people with a pouch develop changes in blood salts or, years later, a low vitamin B12. Routine blood tests at follow-up pick these up.
Can a conduit be changed into a neobladder later?
Rarely, and only in specialist hands. It means a second major operation, and the urethra has to be intact and free of cancer. In practice the choice made before the first operation is the one you live with. Take time over it now.
Who teaches us to manage it at home?
A stoma nurse, before you leave the hospital. For a conduit that means emptying and changing the bag on your own body. For a pouch it means passing the tube yourself under supervision. One family member should learn alongside you.
Is the diversion covered by Aarogyasri or insurance?
The operation usually is, as part of the cystectomy package. The bags, barriers and catheters needed afterwards are treated differently by different schemes, and that ongoing cost is often the bigger surprise. Ask the billing team to cost a year of supplies against your cover.
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Sources
- NHS — Bladder cancer: treatment
- Cancer Research UK — Bladder cancer: treatment
- American Cancer Society — Bladder cancer surgery
- National Cancer Institute — Bladder cancer treatment (PDQ), patient version
- Macmillan Cancer Support — Bladder cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Ileal Conduit ExplainedThe bag option, in detailNeobladder: How It WorksThe no-bag option and what retraining involvesContinent Cutaneous DiversionThe pouch you empty with a tubeHow to Choose Between Conduit and NeobladderWhat the team weighs and what to askStoma Nurses and Support in HyderabadWho teaches you to manage it at home
Talk to us
Deciding on a diversion and not sure what you have been told?
Send us the letter or call the helpline. A surgical oncologist will explain which of the three options are open in your case and why. One helpline serves every CION centre.