6 BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY Males with SCI with unsalvageable bladders secondary to urethral fistula and sacral pressure ulcers. Individuals with bladder cancer requiring cystectomy. 3. Advise individuals undergoing urinary diversion of the following potential complications: Early complications associated with any major intestinal surgery, including anesthetic complications. Prolonged ileus (more common in SCI). Intestinal or urinary leak. Urinary Diversion 1. Consider urinary diversion in the following circumstances: Lower urinary complications secondary to indwelling catheters. Urethrocutaneous fistulas. Perineal pressure ulcers. Urethral destruction in females. Hydronephrosis secondary to a thickened bladder wall. Hydronephrosis secondary to vesicoureteral reflux or failed reimplant. Bladder malignancy requiring cystectomy. 2. Use urinary diversion with caution in individuals who are too debilitated to undergo a major surgical procedure or who have one of the following conditions: Inflammatory bowel disease. Pelvic irradiation. Severe abdominal adhesions from previous surgery. Compromised renal function. Sepsis and wound infection. Ureteroileal stricture. Stomal stenosis. Parastomal hernia. Intestinal obstruction due to adhesions. Urinary infection and stone disease. Cutaneous Ileovesicostomy 1. Consider cutaneous ileovesicostomy for individuals who require urinary diversion with normal ureterovesical junctions. 2. Be prepared to perform secondary procedures that may be needed to prevent urethral incontinence (for example, on the bladder neck in conjunction with augmentation or suprapubic cystostomy or cutaneous ileovesicostomy).