Encyclopedia of Health and Medicine

urinary diversion 223
dures are necessary unless other health concerns
coexist.
Treatment Options and Outlook
Treatment is the appropriate antibiotic medication
to kill the pathogen. It is important to take the full
amount of the antibiotic as prescribed. Though
tempting to stop the medication when symptoms
abate, incomplete treatment allows the BACTERIA to
surge back to reinfect. It also can permit bacteria
to develop resistance to commonly prescribed
antibiotics, requiring more powerful antibiotics for
subsequent treatment. Both GU and NGU can
occur repeatedly when the person becomes reinfected.
Each cycle of infection requires treatment.
It is important (and in many states a legal requirement)
to notify sexual partners so they also can
receive treatment.
Risk Factors and Preventive Measures
The primary risk for GU and NGU infection is
unprotected sex, particularly with multiple partners.
Men who have sex with men are at highest
risk. Safer sex methods, including the use of a
new condom for each sex act, help reduce exposure
to the bacteria that cause urethritis though
are not foolproof. Traumatic urethritis sometimes
becomes chronic in people who must use longterm
bladder catheterization, such as those who
have SPINAL CORD INJURY resulting in paraplegia.
The urologist may prescribe prophylactic antibiotics
and anti-inflammatory medications in such
situations. Diligent PERSONAL HYGIENE further helps
reduce irritation and infection.
See also CHLAMYDIA; CYSTITIS; EPIDIDYMITIS; GONOR-
RHEA; PROSTATITIS; REITER’S SYNDROME; SEXUAL HEALTH;
SEXUALLY TRANSMITTED DISEASES (STDS).
urinary diversion A surgical procedure to create
a method for the storage and passage of URINE
from the body after cystectomy (surgical removal
of the BLADDER). Though most often necessary following
cystectomy to treat BLADDER CANCER or
invasive cancer of the pelvic region, urinary diversion
may be necessary after traumatic injury to
the bladder. Urinary diversion may also be a palliative
treatment for inoperable bladder or pelvic
cancer, diverting the flow of urine to overcome
urinary obstruction. Urinary diversion may be
continent (collects and contains urine within the
body), which most people prefer when it is possible,
or incontinent (collects a steady flow of urine
in a bag outside the body).
Continent Urinary Diversion
When the urethra remains intact the urologic surgeon
can fashion a substitute bladder, called a
neobladder, from a segment of bowel (which has
the ability to expand somewhat), attaching the
ureters and the URETHRA. The neobladder allows the
person to urinate naturally. However, the neobladder
requires more frequent, and usually timed or
scheduled, emptying as it lacks the distention ability
and capacity of the native bladder as well as the
nerves that activate the micturition REFLEX.
When the cystectomy also includes removal of
the urethra, the surgeon generally chooses to craft
a collection reservoir from a segment of SMALL
INTESTINE that remains in the abdominal cavity,
then create a valved opening through the abdominal
wall into the reservoir. The person periodically
inserts a catheter into the opening to drain the
urine, usually every three to four hours, including
through the night. Though not as natural as the
neobladder, the catheter reservoir still permits urinary
continence.
Incontinent Urinary Diversion
Incontinent urinary diversion is similar to the
catheter reservoir, except the opening through the
abdominal wall, called a stoma, lacks a valve. The
person attaches an ostomy bag over the opening
using special adhesive. Urine drains continuously
into the bag, and periodically the person removes
the full bag and replaces it with a clean, empty bag.
The bags are small and unobtrusive beneath the
clothing. The adhesive ensures there is no leakage
of urine. A urostomy bag may require changing
every six to eight hours. Surgeons use this method,
called urostomy or ileal conduit, primarily when
continent urinary diversion is not a viable option.
Outlook and Lifestyle Modifications
Urinary diversion requires diligent attention to
hygiene and emptying collected urine. Though the
neobladder is the most natural urinary diversion