Formation of ileal conduit

What is this?

Diversion of urine to skin with an intestinal stoma

What alternatives are there?

Catheters, bladder enlargement, continent diversion (a catheterisable pouch), depending on the reason why the stoma is being formed

What to expect before procedure

You will be seen by a Stoma Nurse Specialist before your operation to discuss life with a urostomy and to try the various drainage bags available. If you wish, you will given the opportunity to meet someone who has previously had this procedure. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. You will come into hospital on the day before surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer, and your named nurse. From the day before your operation you will have only fluids by mouth and nothing by mouth for 6 hours before surgery. You will also be given an enema to ensure that you pass a bowel motion on the morning of surgery. You will be seen by the Stoma Nurse Specialist before your operation to mark the site where your stoma will be positioned. You will also be seen by the anaesthetist before the operation. You will be given intravenous antibiotics at the time the anaesthetic is given, and possibly after surgery too. You may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

A full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which produces freedom from pain post-operatively. In the operation, the ureters (the tubes which drain urine from the kidneys to the bladder) are sewn to an isolated segment of small bowel which is positioned on the surface of the abdomen as an opening called a urostomy. The ends of the small bowel, from which the conduit is isolated, are then joined together again

After the procedure

The average stay in hospital will last approximately 10-14 days Drainage tubes will be placed through the stoma up to the kidneys, for about a week. There will be a drainage tube close to the wound, to drain fluid away from the internal area where the operation has been done. A tube may be placed through the nose to drain the stomach. After your operation, you may be in the Intensive Care Unit or the Special Recovery area of the operating theatre before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will have a drip in your arm and you may have a further drip into a vein in your neck. You will be encouraged to mobilise as soon as possible after the operation because this encourages the bowel to begin working. We will start you on fluid drinks and food as soon as possible. Normally, we use elastic stockings to minimise the risk of a blood clot (deep vein thrombosis) in your legs. A physiotherapist will come and show you some deep breathing and leg exercises, and you will sit out in a chair for a short time soon after your operation. You or your carer will be shown by the Stoma Care Nurse how to empty and change the stoma bags, and you or your carer will be confident doing this before you go home. It will, however, take at least 3-6 months for you to recover fully from this surgery, although much of the recovery comes a good deal sooner than this.

Potential side effects