Nursing care
Urinary Diversion Care: the nurse's role, start to finish
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated September 2026
Short answer
Urinary diversion reroutes urine flow after bladder removal or dysfunction, most commonly through an ileal conduit. Nursing management centres on stoma assessment, a pink and moist stoma is expected, a dusky or dark one is an emergency, and recognising that mucus in the urine is normal because the conduit is built from bowel tissue.
When it is done and why
Urinary diversion is most often performed after cystectomy for bladder cancer, but it is also used for neurogenic bladder, radiation damage, or congenital anomalies where the bladder cannot safely store or empty urine.
The ileal conduit is the most common type: a segment of ileum is isolated, the ureters are implanted into it, and the other end is brought to the skin as a stoma. Continent diversions and orthotopic neobladders are alternatives, but they carry different self-catheterization or voiding requirements the nurse must know before teaching.
Because a bowel segment is now carrying urine, some of its native bowel function persists. That single fact underlies several findings nurses need to expect rather than treat as abnormal.
Preparing the patient
Preoperative teaching should set realistic expectations: what the stoma will look like, where it will sit, and that appliance changes become routine within weeks even though they feel unmanageable at first. Involving a wound, ostomy and continence nurse before surgery improves long-term adaptation.
Stoma site marking is done preoperatively with the patient sitting, standing, and lying down, avoiding skin folds, scars, and the beltline, since a poorly placed stoma is a lifelong problem, not a temporary inconvenience.
Address the psychological weight of the surgery directly. Body image, sexual function, and clothing choices are legitimate concerns, and patients who can voice them before surgery generally cope better afterward.
The steps that matter for safety
Confirm ureteral stents or catheters are correctly labelled and secured before and immediately after surgery, since these maintain urine flow while the anastomosis heals and accidental dislodgement is a genuine risk.
Verify the type of diversion in the chart matches what the surgeon documents intraoperatively, an ileal conduit is managed differently to a continent pouch, and a nurse working from the wrong assumption will teach the wrong self-care.
Confirm baseline renal function and electrolytes preoperatively, since the bowel segment used can reabsorb some urinary solutes and this needs a comparison point postoperatively.
During the procedure — the nurse's role
Intraoperative nursing focuses on positioning, maintaining stoma-marking integrity, and accurate specimen and stent labelling as the surgical team implants the ureters and matures the stoma.
Fluid balance monitoring intraoperatively matters because bowel manipulation and urine diversion both affect intravascular volume, and the anesthesia team relies on accurate input and output tracking throughout.
Close communication with the surgical team on stent placement and stoma maturation technique prepares the postoperative nurse for what a normal early stoma should look like versus a technical complication.
After: monitoring and complications
Assess the stoma every shift in early recovery: it should be pink to red and moist, similar to the inside of the cheek. A dusky, pale, or black stoma signals compromised blood supply and needs an urgent surgical call, not a wait-and-see approach.
Mucus in the urine is expected and not a sign of infection, because the conduit is built from bowel mucosa that continues to secrete mucus even while carrying urine. Cloudy urine from mucus alone should not automatically trigger antibiotics without other infection signs.
Monitor urine output closely through the stoma, watch for stent output specifically if stents are in place, and assess peristomal skin for irritation from urine contact, since urine is more caustic to skin than stool and breakdown can happen quickly if the appliance fits poorly.
Documentation and teaching
Document stoma colour, size, output volume and character, and peristomal skin condition each shift, since these baseline notes are what later staff compare against to catch a subtle change early.
Teach appliance care hands-on before discharge: emptying technique, when to change the entire pouch versus just checking the seal, and how to measure the stoma as it shrinks over the first weeks after surgery.
Teach patients to recognise and report a stoma that changes colour, urine that becomes foul-smelling or is accompanied by fever or flank pain, and skin breakdown around the stoma, and reassure them that clear or stringy mucus alone is not one of those warning signs.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our renal and genitourinary practice questions are the closest set to what this page covers.
Common questions
Is mucus in urinary diversion urine a sign of infection?
No, mucus is expected because the conduit is made from a segment of bowel that continues its normal mucus secretion. It only becomes concerning alongside other signs like fever, foul odor, or flank pain.
What stoma colour requires an urgent call to the surgeon?
A dusky, pale, or black stoma indicates compromised blood supply and needs immediate surgical notification. A healthy stoma should be pink to red and moist.
What is the difference between an ileal conduit and a continent urinary diversion?
An ileal conduit drains continuously through a stoma into an external appliance, while a continent diversion or neobladder allows the patient to store urine internally and empty it through self-catheterization or, with a neobladder, near-normal voiding. Nursing teaching differs significantly between the two.
How often should stoma output be assessed after surgery?
Output, colour, and peristomal skin should be checked at least every shift in the immediate postoperative period, more frequently if stents are in place or output is abnormal. Any sudden drop in output should be reported promptly since it may indicate obstruction.