How do you pee if your bladder is removed

Bladder removal, medically known as cystectomy, is a surgical procedure typically performed to treat various medical conditions, such as cancer or severe bladder damage. After the removal of the bladder, individuals are left with the question of how they will manage the storage and elimination of urine. This article aims to provide an in-depth understanding of the alternative methods used by people who have undergone a cystectomy, exploring the various types of urinary diversions and their associated surgical techniques.

How to Urinate After Bladder Removal

After a cystectomy (bladder removal), urination is significantly altered. The urinary system is rerouted, and the process depends on the type of urinary diversion surgery performed. There is no "natural" urination anymore; instead, a new pathway is surgically created to allow urine to exit the body. This new pathway can involve either an internal or external opening, and managing it requires specific techniques and ongoing care.

Urinary Diversion Options

Several different surgical procedures can create a new urinary pathway after bladder removal. The specific method used depends on various factors, including the patient's overall health, the extent of the bladder cancer, and surgeon preference. Common options include ileal conduit, ileal neobladder, and continent cutaneous diversion. Each option has its own unique characteristics impacting how a person urinates.

Ileal Conduit (Urostomy):

In an ileal conduit, a section of the small intestine is used to create a new pathway for urine to leave the body. One end of this intestinal segment is attached to the ureters (tubes connecting the kidneys to the bladder), and the other end is brought out through an opening in the abdomen, creating a stoma. Urine drains continuously into a pouch attached to the stoma. This requires the consistent use of an external pouch to collect urine, which needs to be emptied regularly. It is not a natural process of urination, as there is no control over the urine flow.

Ileal Neobladder (Orthotopic Neobladder):

An ileal neobladder uses a section of the small intestine to reconstruct a new bladder. The ureters are connected to this new bladder, and the neobladder is connected to the urethra, allowing urine to flow from the neobladder to the outside. While this allows for a more natural form of urination, it does still require the patient to learn how to manage their urinary function and may not always be completely continent.

Continent Cutaneous Diversion:

This is a more complex surgery designed to create a continent urinary reservoir. A pouch is constructed from a section of the bowel and connected to the ureters. A valve mechanism is created to prevent urine leakage. Urine is then emptied periodically through a catheter inserted into a stoma. It offers greater control over urination and a more normal lifestyle, but requires regular catheterization.

Catheterization Techniques:

Depending on the type of diversion, catheterization may be necessary to empty the urine from the bladder or reservoir. This is a process of inserting a thin tube into the stoma or urethra to drain urine. Patients are typically trained on proper catheterization techniques before discharge from the hospital. Regular and careful catheterization is essential to prevent infections and maintain urinary health.

Diversion Type	Method of Urination	Level of Control	Care Requirements
Ileal Conduit	External pouch	None	Pouch changes, skin care
Ileal Neobladder	Through urethra	Variable, often with some incontinence	Regular emptying, possible medications
Continent Cutaneous Diversion	Intermittent catheterization	Good	Clean intermittent catheterization

How to Urinate After Bladder Removal

After a cystectomy (bladder removal), urination is significantly altered. The urinary system is rerouted, and the process depends on the type of urinary diversion surgery performed. There is no "natural" urination anymore; instead, a new pathway is surgically created to allow urine to exit the body. This new pathway can involve either an internal or external opening, and managing it requires specific techniques and ongoing care.

Urinary Diversion Options

Several different surgical procedures can create a new urinary pathway after bladder removal. The specific method used depends on various factors, including the patient's overall health, the extent of the bladder cancer, and surgeon preference. Common options include ileal conduit, ileal neobladder, and continent cutaneous diversion. Each option has its own unique characteristics impacting how a person urinates.

Ileal Conduit (Urostomy):

In an ileal conduit, a section of the small intestine is used to create a new pathway for urine to leave the body. One end of this intestinal segment is attached to the ureters (tubes connecting the kidneys to the bladder), and the other end is brought out through an opening in the abdomen, creating a stoma. Urine drains continuously into a pouch attached to the stoma. This requires the consistent use of an external pouch to collect urine, which needs to be emptied regularly. It is not a natural process of urination, as there is no control over the urine flow.

Ileal Neobladder (Orthotopic Neobladder):

An ileal neobladder uses a section of the small intestine to reconstruct a new bladder. The ureters are connected to this new bladder, and the neobladder is connected to the urethra, allowing urine to flow from the neobladder to the outside. While this allows for a more natural form of urination, it does still require the patient to learn how to manage their urinary function and may not always be completely continent.

Continent Cutaneous Diversion:

This is a more complex surgery designed to create a continent urinary reservoir. A pouch is constructed from a section of the bowel and connected to the ureters. A valve mechanism is created to prevent urine leakage. Urine is then emptied periodically through a catheter inserted into a stoma. It offers greater control over urination and a more normal lifestyle, but requires regular catheterization.

Catheterization Techniques:

Depending on the type of diversion, catheterization may be necessary to empty the urine from the bladder or reservoir. This is a process of inserting a thin tube into the stoma or urethra to drain urine. Patients are typically trained on proper catheterization techniques before discharge from the hospital. Regular and careful catheterization is essential to prevent infections and maintain urinary health.

Diversion Type	Method of Urination	Level of Control	Care Requirements
Ileal Conduit	External pouch	None	Pouch changes, skin care
Ileal Neobladder	Through urethra	Variable, often with some incontinence	Regular emptying, possible medications
Continent Cutaneous Diversion	Intermittent catheterization	Good	Clean intermittent catheterization

What happens to your urinary system after bladder removal?

When your bladder is removed, a procedure called a cystectomy, your urinary system needs to be rerouted. This is because the bladder is essential for storing urine produced by your kidneys. There are several different ways your surgeon can reroute your urinary system, depending on factors like your overall health, the reason for bladder removal (e.g., cancer), and your individual anatomy. One common method involves creating a new urinary diversion, which is essentially a new pathway for urine to exit the body. This often involves using a section of your intestine to create a pouch (neobladder) or a conduit that connects the ureters (tubes that carry urine from your kidneys to your bladder) to an opening on your abdomen called a stoma. The stoma will require a pouch to collect urine. Another option, if your ureters are healthy enough, is to connect them directly to the urethra (ureterostomy), though this is less common. The specific surgical technique and the resulting changes to your urinary system will be discussed extensively with your doctor prior to the procedure.

How do I urinate after a cystectomy?

The way you urinate after a cystectomy depends entirely on the type of urinary diversion your surgeon creates. If you have a neobladder, you might be able to urinate normally through your urethra, much like you did before the surgery. However, this may require retraining your bladder muscles and may not be completely successful for everyone. You may experience some incontinence, meaning accidental leakage of urine. With a stoma and collection bag, you will need to empty the bag regularly throughout the day. The process is similar to using a catheter, but instead of inserting a catheter, you empty a pouch attached to your abdomen. You will need to learn how to properly care for your stoma and pouch to prevent infection and maintain hygiene. If you have a ureterostomy, urine will drain directly from your ureters through a stoma on your abdomen, requiring a similar collection and care process as with a neobladder/stoma diversion. Your healthcare team will provide detailed instructions on how to manage your new urinary system post-surgery, including the frequency of emptying and how to identify and address potential complications. Regular follow-up appointments are crucial for monitoring your health and ensuring you can manage the changes effectively.

What are the potential complications of bladder removal and urinary diversion?

Bladder removal and urinary diversion are major surgeries and carry several potential complications. These can include infection at the surgical site, bleeding, blood clots, kidney problems, leaks at the site of the urinary diversion, and blockages in the urinary tract. Depending on the type of diversion, you may experience incontinence, frequent urination, or difficulty controlling urine flow. There's also a risk of stoma complications, such as irritation, skin breakdown around the stoma, or infection. In some cases, there may be issues with the neobladder, such as inadequate capacity or difficulty emptying it. You might also experience issues like electrolyte imbalances. Your surgical team will thoroughly discuss these potential complications before the procedure and will provide ongoing support and monitoring to help minimize these risks. Open communication with your medical team is essential to managing any complications that may arise.

Will I need ongoing medical care after bladder removal?

Yes, you will require ongoing medical care after bladder removal and urinary diversion. This will involve regular follow-up appointments with your surgeon and other specialists, such as urologists, nurses, and possibly dieticians. Regular monitoring is necessary to check for complications and ensure your urinary diversion is functioning properly. You'll also need to learn how to care for your stoma (if applicable) and to manage any changes in your bowel habits, which can also be impacted by the surgery. You may require periodic lab tests to monitor your kidney function and electrolyte levels. Depending on your individual circumstances, you may also need to attend therapy sessions, such as physical therapy or ostomy care education to help you adjust to the changes and improve your quality of life. Consistent communication with your healthcare team is paramount for managing your long-term health and wellbeing after this significant surgery.