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Urinary diversion after pelvic exenteration: where the urine goes now | CION Cancer Clinics
A urinary diversion is the new route built for urine once the bladder has been removed. The kidneys keep working; only the path out changes. After pelvic exenteration the usual choice is an ileal conduit, a short tube made from your own small bowel that carries urine to a bag on the abdomen. This page explains why it is done that way, what the alternatives are and who they do not suit, and what to expect in the first weeks. 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 is a urinary diversion, and why do I need one?
- Which kinds of diversion exist, and who each one suits
- What happens with the diversion after the operation
- Words you will meet, in plain language
- Three things families ask about the new urine route
- What this page cannot tell you
- Common questions about urinary diversion
The short answer
What is a urinary diversion, and why do I need one?
A urinary diversion is a new route for urine to leave the body once the bladder has been removed. The kidneys keep working as before; what changes is where the urine goes. After pelvic exenteration the usual diversion is an ileal conduit, a short tube made from your own small bowel that carries urine to an opening on the abdomen and into a bag.
Why the surgeon cannot simply leave the tubes open
The two thin tubes from the kidneys, called ureters, cannot be brought to the skin on their own. They are too narrow, they scar shut, and they would leave the kidneys open to infection. Joining them to a piece of bowel gives urine a wide, well-supplied channel that stays open for life.
Why bowel is used
Bowel has a good blood supply, stretches, and can be cut and rejoined without harm to the rest of the gut. The surgeon takes a short length of small bowel, joins the ureters into one end, and brings the other end out through the abdominal wall as a small pink spout. The remaining bowel is joined back together.
Because a piece of bowel is borrowed, the gut is slower to wake after the operation, and eating restarts gradually. This is expected.The options
Which kinds of diversion exist, and who each one suits
After exenteration, most people are offered the first of these. The others exist, and it is fair to ask about them.
Ileal conduit (urostomy)
The standard choice. Urine drains all the time into a bag stuck to the abdomen, which you empty through a tap. It is the simplest to make, the simplest to live with, and the one with the fewest things that can go wrong later.
Usually chosen when
- The pelvis has had radiotherapy before
- The operation is already long
- The kidneys are not working perfectly
Continent pouch
A reservoir made from bowel sits inside the abdomen and is emptied several times a day by passing a thin tube through a small opening. There is no bag, but the pouch needs regular emptying and flushing for life, and it carries more risk of leaks and stones.
Not usually offered after radiotherapy or when the kidneys are already under strain.Double-barrelled wet colostomy
Urine and stool are brought out through a single stoma, with the ureters joined to the bowel just above it. It means one bag instead of two, but urine and stool mix, and infection of the kidneys is a greater worry. A few centres use it; many do not.
Not sure whether this applies to you?
Ask an oncologistThe first weeks
What happens with the diversion after the operation
Stents protect the joins
Two very fine tubes are left running from the kidneys through the conduit and out into the bag. They keep the joins open while they heal. You may see them poking out of the stoma; that is expected.
The stoma is checked daily
A healthy conduit stoma is pink and moist, and swollen at first. The nurses watch its colour and the amount of urine in the bag, because both tell them the blood supply and the kidneys are fine.
The stents come out
Usually at a clinic visit a few weeks after the operation. It takes a moment and does not need an anaesthetic. After this the stoma settles to its final size, and your bags are refitted.
Kidney checks continue
Blood tests and a scan of the kidneys are repeated at follow-up for years, because the join between ureter and bowel can narrow slowly without causing pain. Catching that early protects the kidney.
On your reports
Words you will meet, in plain language
- Ureter
- The thin tube that carries urine from each kidney down to the bladder. There are two, and both are joined to the conduit.
- Ileal conduit
- The piece of small bowel used as the new channel for urine. "Ileal" means it comes from the ileum, the last part of the small bowel.
- Stent
- A fine tube left inside the join to hold it open while it heals. Removed at a clinic visit.
- Stricture
- A narrowing, usually at the join between ureter and conduit, which can slow the flow from a kidney. Watched for on scans at follow-up.
- Creatinine
- A blood test that shows how well the kidneys are working. It is checked at every follow-up after a diversion.
- Hydronephrosis
- A kidney that is swollen because urine is not draining freely. On a scan report it is a reason to look for a narrowing, not an emergency in itself unless there is fever or pain.
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Commonly believed
Three things families ask about the new urine route
"With no bladder, she will be on dialysis."
The bladder only stores urine; it does not make it or clean the blood. That is the kidneys' job, and they are untouched. As long as urine drains freely through the conduit, the kidneys carry on as before. Dialysis is not part of this operation.
"An internal pouch is always better than a bag."
A pouch avoids the bag but needs emptying with a tube several times a day and night for life, and it has more ways to go wrong, especially in a pelvis that has had radiotherapy. For many people the conduit is the safer and simpler choice. Which is right for you is a conversation with your surgeon, not a ranking.
"Cloudy urine in the bag means infection."
Usually not. The conduit is made of bowel, and bowel makes mucus, so strands and cloudiness in the bag are normal. Infection shows itself as fever, pain in the back or side, or urine that suddenly smells much stronger. Those need a doctor the same day; cloudiness alone does not.
Being straight with you
What this page cannot tell you
This page cannot tell you which diversion you will have. That depends on whether you have had radiotherapy, how well your kidneys work, how long the operation is already expected to take, and what your surgeon does regularly. The decision is made before the operation, with you, and it is worth asking why the chosen one suits you.
Who a pouch does not suit
A pouch is usually not offered to people who have had pelvic radiotherapy, whose kidneys are already under strain, who cannot manage passing a tube several times a day, or where the operation is already very long. If you are told it is not suitable, ask which of these is the reason.
Questions worth asking your surgeon
Which diversion are you planning, and why that one for me. Will I go home with stents in. How often will my kidneys be checked afterwards. What should I do if the output in the bag drops. Who looks after the stoma once I am home.
If you have been given a plan you do not understand, call the helpline. An oncologist will go through it with you.
Did you know
The spot for the urostomy is marked on your abdomen before the operation, with you sitting, standing and bending, so that it lands on flat skin you can see and reach, clear of your waistband and any skin fold. A well-placed stoma is the single biggest factor in bags that do not leak.
Questions we are asked
Common questions about urinary diversion
Will I feel the need to pass urine?
No. The bladder is what gives the feeling of fullness, and it has been removed. Urine drains steadily from the conduit into the bag without any sensation, day and night. You learn to empty the bag by the clock rather than by any urge.
Does the stoma hurt?
The stoma itself has no nerve supply for pain, so touching it or changing the bag does not hurt. The skin around it can become sore if urine leaks under the plate, which is why a good seal matters. Pain inside the abdomen or in the back is different and should be reported.
Why is there blood on the stoma when I clean it?
A few spots of blood from the surface of the stoma when it is wiped are normal, because the bowel lining is rich in tiny blood vessels. Blood inside the urine in the bag, or bleeding that does not stop, is not normal and should be checked the same day.
Can the conduit be changed to a pouch later?
Occasionally, but it is a second major operation and most people who ask about it are found not to be suitable, for the same reasons a pouch was not offered the first time. If living without a bag matters a great deal to you, raise it before the first operation, when the choice is real.
Will I get more kidney infections?
The risk is higher than before, because there is no bladder valve between the outside and the kidneys. Drinking plenty of water, emptying the bag regularly, keeping a good seal and using a night bag all reduce it. Fever with back pain needs treatment the same day, because a kidney infection can become serious quickly.
How much should I drink?
More than you did before, and steadily through the day rather than all at once. Your team will give you a target that suits your kidneys and the heat where you live. Pale, free-flowing urine in the bag is the sign you are drinking enough. Dark, scanty urine means drink more and, if it persists, call.
Why do my blood tests show a change in salts?
The piece of bowel used for the conduit can absorb some of the salts in the urine that passes through it. In a short conduit this is usually small, but it is one reason your blood is checked at follow-up. If it matters, your doctor will prescribe something to correct it.
Is the operation to make the conduit covered by my scheme?
The diversion is part of the exenteration and is usually covered together with it under Aarogyasri, CGHS, ECHS, EHS and most cashless insurers. Ongoing bags and supplies after discharge are covered less consistently, so ask about that before the operation. Call the helpline if you want help checking your cover.
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Sources
- NHS — Urostomy
- Cancer Research UK — Bladder cancer treatment
- American Cancer Society — Bladder Cancer Surgery
- Cancer Research UK — Pelvic exenteration for cervical 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
Living With Two StomasDaily life with the urostomy and the colostomyPelvic Exenteration: What the Operation RemovesWhy the bladder is removed in the first placeDrains, Tubes, Lines and CathetersThe stents and drains you will see after the operationComplication Rates After Exenteration: The Honest PictureWhat can go wrong with the diversion, in sourced figuresLife a Year After Pelvic ExenterationHow the diversion settles over time
Talk to us
Questions about the diversion you have been offered?
Send us the surgeon's letter or call the helpline. A surgical oncologist will explain which diversion is planned and why. One helpline serves every CION centre.