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Urinary diversion when advanced cancer blocks or leaks | CION Cancer Clinics
Palliative urinary diversion gives urine a new way out when cancer has blocked the kidneys or caused a constant leak. Most people are offered a tube first, either a stent inside or a nephrostomy through the back. An operation that creates a urine stoma is usually kept for leaks or bleeding a tube cannot fix. None of these treat the cancer itself. They aim to protect the kidneys and make daily life easier. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is palliative urinary diversion?
- Which ways of redirecting urine might be offered?
- When is an operation considered instead of a tube?
- What usually happens if surgery is planned?
- What do families often believe about a urine bag?
- Which words will you see on the scan or discharge notes?
- What can this page not tell you?
- Common questions about urinary diversion in advanced cancer
The short answer
What is palliative urinary diversion?
Palliative urinary diversion means giving urine a new way out of the body when cancer has blocked, damaged or broken into the normal route. The aim is comfort and protecting the kidneys, not removing the cancer.
Why urine gets blocked in advanced cancer
Urine travels from each kidney down a thin tube called the ureter, into the bladder, and out. Cancers of the bladder, cervix, womb, prostate, rectum and ovary can press on these tubes or grow into them. When the flow stops, urine backs up into the kidney. The kidney swells, stops working well, and waste builds up in the blood. You may notice less urine, swelling of the legs, sickness, confusion or pain in the back.
When the problem is a leak, not a blockage
Sometimes the cancer, or earlier radiotherapy, makes an opening between the bladder and the vagina or bowel. Doctors call this a fistula. Urine then leaks all day and night. The skin becomes sore, the smell is hard to live with, and many people stop leaving the house. A diversion can stop urine reaching that opening at all.
What diversion does not do
It does not shrink the cancer or change its course. It treats one problem that is making life harder. Whether that is worth doing depends on how much the problem is affecting daily life and how well the person is otherwise.
The options
Which ways of redirecting urine might be offered?
Most people are offered a tube first. An operation is usually considered only when a tube is not possible or has stopped working.
Ureteric stent
A thin, soft tube placed inside the ureter using a camera passed up through the bladder, usually under anaesthesia. Nothing shows outside the body.
Worth knowing
- Needs changing at intervals
- Can be hard to place if the cancer squeezes tightly
Nephrostomy
A tube placed through the skin of the back straight into the kidney, guided by a scan. Urine drains into a bag outside the body.
Often done under local anaesthetic, which helps when someone is too unwell for a general one.Suprapubic catheter
A tube placed through the lower tummy into the bladder. It helps when the outflow from the bladder is blocked, but not when the ureters are.
Surgical diversion
The ureters are joined to a short piece of bowel that opens onto the tummy as a stoma, a small opening where urine drains into a bag. This is called an ileal conduit or urostomy.
Usually considered for
- A fistula that leaks constantly
- Bleeding from the bladder that will not settle
Not sure whether this applies to you?
Ask an oncologistWeighing it up
When is an operation considered instead of a tube?
An operation is a bigger step than a tube. It means a general anaesthetic, a stay in hospital and a recovery that takes weeks, not days. So teams usually keep it for problems a tube cannot solve.
What the team weighs
They look at how much the problem is costing the person each day, whether a tube has already failed, how strong the heart, lungs and nutrition are, and how the cancer is expected to behave in the coming months. They also ask what the person wants. Some people would accept a hard recovery to be dry again. Others would rather avoid hospital altogether.
Who it may not suit
A major diversion is often not suitable for someone who is in bed most of the day, very weak, losing weight fast, or whose bowel is also affected by the cancer. Previous pelvic radiotherapy can make the bowel harder to use and slower to heal. In these situations a nephrostomy may give most of the benefit with far less strain.
Choosing not to divert
Sometimes the kinder choice is to leave the kidneys blocked and focus on comfort. This is a real option, not a failure, and the team should talk it through openly if it applies.
The pathway
What usually happens if surgery is planned?
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Blood tests and scans
Kidney function, blood counts and a scan show where the blockage or leak sits and how the kidneys are coping. A tube may be placed first to protect the kidneys while you decide.
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Meeting the stoma nurse
Before the operation, a nurse marks the spot on your tummy where a bag will sit comfortably, checked while sitting and standing, and shows you what a bag looks like.
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The operation
Done under general anaesthesia. You wake with thin tubes coming out of the new stoma and a bag already in place.
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The first days on the ward
Eating restarts slowly because a piece of bowel was used. Walking starts early. A family member is taught to empty and change the bag.
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Home and follow-up
You go home with supplies and a number to call. Kidney blood tests and stoma checks continue, alongside support from the palliative care team.
Leave a number, we will call you
One field. No form to fill in, and no charge for the call.
Commonly believed
What do families often believe about a urine bag?
"A bag means the person can never go out again."
Modern bags sit flat under clothes and do not smell when fitted well. Many people find they go out more, because the constant leaking and wet clothes have stopped.
"If the kidneys are blocked, a tube must always be put in."
Not always. Draining a blocked kidney helps some people feel much better. For others near the end of life it adds tubes and hospital visits without improving comfort. It is a choice to talk through, not an automatic step.
"The operation will stop the cancer growing."
Diversion moves urine away from the problem area. It does not treat the cancer itself. Any treatment for the cancer is a separate decision with your oncologist.
On your report
Which words will you see on the scan or discharge notes?
- Hydronephrosis
- A kidney swollen with urine that cannot drain. It can affect one kidney or both.
- Ureteric obstruction
- A blockage of the tube that carries urine from the kidney to the bladder.
- Creatinine
- A blood test that rises when the kidneys are not clearing waste well. Teams watch it before and after any drainage.
- Vesicovaginal or vesicorectal fistula
- An abnormal opening between the bladder and the vagina, or the bladder and the back passage.
- Ileal conduit
- A short piece of small bowel used as a channel to carry urine out to a stoma.
Being straight with you
What can this page not tell you?
This page cannot tell you whether diversion is right for you or your parent. That depends on scans, blood tests, the type of cancer, what has already been tried and what the person wants from the time ahead.
It cannot predict how long a tube or stoma will be needed
Some people live with a nephrostomy or urostomy for a long time. For others it is needed for a short while. Nobody can read that from a scan alone, and nobody should promise a figure.
Questions worth taking to the appointment
Ask what problem the procedure is meant to fix, and what happens if you do nothing. Ask whether a tube could do the same job. Ask who will change the tube or supply the bags once you are home, and whom to call at night. If you live outside Hyderabad, ask where the nearest place is that can change a blocked tube.
Questions we are asked
Common questions about urinary diversion in advanced cancer
How do we know the kidneys are blocked?
An ultrasound or CT scan shows swelling of the kidney, and a creatinine blood test shows whether waste is building up. Signs at home include passing much less urine, feeling sick, sleepiness, confusion or new back pain. Any of these in someone with a pelvic cancer is worth reporting to the team the same day.
Is a nephrostomy or a stent the better choice?
Neither suits everyone. A stent sits inside, so there is no bag, but it can be hard to place past a tight blockage and may block again. A nephrostomy is easier to place and drains reliably, but you live with a tube and bag on the back. Your team explains which is likely to work for the blockage you have.
Will my father need the bag for the rest of his life?
A surgical diversion is usually permanent. A tube sometimes comes out if the cancer shrinks with other treatment, but in advanced disease it often stays. Ask the team directly whether the plan is temporary or lasting, so the family can prepare for looking after it at home.
Who looks after the stoma or tube at home?
Usually a family member, after being taught on the ward. Emptying a bag takes a few minutes. Tubes need changing at planned visits, and bags need regular replacement. Ask before discharge where supplies come from, what they cost, and who to call if the bag leaks or the tube stops draining.
What if the tube falls out or stops draining?
Call the team or go to hospital the same day. A tube that has come out can sometimes be replaced through the same track if done quickly. Also report fever with shivering, blood clots in the bag, or pain at the tube site, because these can signal infection or a blockage.
Can this be done if she has had radiotherapy to the pelvis?
Often yes, but it changes the plan. Radiotherapy can scar the bowel and slow healing, so surgeons may choose a different piece of bowel or favour a tube instead. Bring the radiotherapy summary to the appointment. It matters more than most families expect.
Does draining the kidneys mean more cancer treatment becomes possible?
Sometimes. Some chemotherapy medicines need the kidneys working well, so clearing a blockage can open that door. It is not always the reason to do it, though. Ask your oncologist whether drainage changes what treatment is possible, or whether the aim is comfort alone.
Is it covered by Aarogyasri or insurance?
Procedures for cancer-related urinary blockage are often covered when they are part of a treatment plan. Aarogyasri, CGHS, ECHS, EHS and cashless insurance are accepted at CION. Call the helpline with your card details and we will check your cover before admission, including what is included for bags and tube changes.
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Sources
- NHS — Urostomy
- Cancer Research UK — Bladder cancer
- Macmillan Cancer Support — Cancer information and support
- National Cancer Institute — Palliative care in 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.
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