Reference — Renal
Urinary Diversion & Stoma Care Reference
When the bladder is removed (usually for cancer), urine needs a new route out. The three options differ in whether the patient wears a pouch, catheterizes, or voids— with the ileal conduit the most common.
Educational use only. Surgical approach and stoma management are provider/WOC-nurse-directed and individualized. This reference is an educational aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Types of Urinary Diversion
| Type | How it works | Drainage | Notes |
|---|---|---|---|
| Ileal conduit (incontinent urostomy) | Ureters drain into an ileal segment that exits as a stoma | Continuous — needs an external pouch worn at all times | Most common; spouts urine constantly; a healthy stoma is pink/red and moist |
| Continent cutaneous reservoir | Internal pouch from bowel with a continent stoma | Drained by intermittent catheterization through the stoma | No external bag; patient catheterizes on a schedule |
| Orthotopic neobladder | Bowel reservoir connected to the urethra | Voided through the urethra (or catheterized) — no abdominal stoma | Most 'normal' voiding route; nighttime incontinence common; may need to learn to void |
Stoma Assessment & Skin Care
A healthy urostomy stoma is pink to red, moist, and slightly raised. Report a dusky, pale, dark, or black stoma (ischemia/necrosis) urgently. Protect peristomal skin with a well-fitted appliance (urine is irritating), keep the pouch emptied (about one-third to one-half full), and ensure continuous drainage — connect to a bedside bag at night. Mucus in the urine is normal because the conduit/reservoir is made from bowel; encourage fluids to flush it.
Patient Teaching
Teach appliance application and emptying, peristomal skin protection, signs of stoma problems and UTI, and adequate hydration. Reassure that mucus is expected. For continent reservoirs/neobladders, teach the catheterization or voiding schedule. Involve a wound-ostomy-continence (WOC) nurse early, address body image and intimacy, and connect patients to ostomy support resources.
NCLEX Pearls
- ✦Ileal conduit = incontinent urostomy → continuous urine output, needs a pouch worn at all times (most common).
- ✦Continent cutaneous reservoir = no bag, drained by intermittent catheterization; neobladder = voided via the urethra.
- ✦Healthy stoma = pink/red and moist; dusky, dark, or black = ischemia → report immediately.
- ✦MUCUS in the urine is NORMAL with bowel-segment diversions — encourage fluids.
- ✦Protect peristomal skin (urine is irritating) and empty the pouch when ~1/3–1/2 full.
- ✦Involve a WOC nurse early; address body image, and teach signs of UTI/stoma problems.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with KDIGO Clinical Practice Guidelines · National Kidney Foundation (NKF). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →