People with tetraplegia, especially females, often have difficulty performing clean intermittent catherization. In addition, females are more troubled by persistent incontinence. The surgical methods described in this section can result in the ability to self-catheterize, allowing the individual to benefit from intermittent rather than indwelling bladder catheterization, the latter being associated with a higher rate of complications. The mitrofanoff channel involves the use of an autologous tubular structure, usually the appendix, as a cutaneous catheterizable stoma. Implantation in the bladder via a submucosal tunnel provides continence to the conduit (Zommick et al. 2003; Sylora et al. 1997). The stoma can be hidden in the umbilicus. While performed often in children, the procedure has less commonly been performed in adults. Long term followup is reportedly good up to 60 months (Zommick et al. 2003 [n=7]; Hakenberg et al, 2001 [n=4]), but has not been reported with respect to the potential for malignancies. Karsenty et al. (2008) describes a similar procedure, performed in 13 patients with incontinence and inability to self-catheterize.
Ileal conduit diversion, another surgical approach more commonly performed in females, is also often considered for reasons of lack of manual dexterity or ease of care and convenience (Pazooki et al. 2006; Chartier-Kastler et al. 2002). This technique aims to establish low-pressure urinary drainage by diverting urine prior to entering the bladder and connecting the ureters to an external urinary collection system via a catheter passed through the ileal lumen. This procedure is sometimes conducted along with removal of the bladder as well (Chartier-Kastler et al. 2002; Kato et al. 2002). Peterson et al. (2012) observed that during the period from 1998 to 2005 in the USA, urinary diversion was used more frequently by older patients (>41 years, reliant on Medicare) than bladder augmentation as the treatment choice. But due to missing data (e.g., level of injury, failed previous bladder augmentation, renal function status, etc.), the reasons behind treatment choices are not completely understood.