What replaces a bladder when removed

When the bladder is removed, whether due to cancer, birth defects, or other medical conditions, the question of what will replace it becomes paramount. The urinary bladder serves a vital function in storing and expelling urine, and its removal necessitates a solution to maintain urinary function and preserve quality of life. This article delves into the various options available to replace the bladder after removal, exploring their advantages, disadvantages, and suitability for different patients. From artificial urinary bladders to urinary diversion techniques, we will delve into the latest advancements and best practices to restore urinary function and improve patient outcomes after bladder removal.

What Replaces a Bladder When Removed?

When a bladder is surgically removed (a procedure called a cystectomy), it needs to be replaced to manage urine. The method used depends on several factors, including the patient's overall health, the reason for bladder removal (often bladder cancer), and the surgeon's preference. There isn't one single "replacement," but rather several options designed to divert urine from the body.

Ileal Conduit (Urinary Diversion)

This is a common urinary diversion procedure. A segment of the small intestine (ileum) is surgically removed and reshaped into a small pouch. One end of this pouch is connected to the ureters (tubes that carry urine from the kidneys), and the other end is brought out through an opening in the abdomen called a stoma. Urine drains into a pouch attached to the stoma, which the patient must empty regularly.

Neobladder (Orthotopic Neobladder)

A neobladder is a surgically constructed bladder created from a section of the bowel (usually the intestine). This new bladder is connected to the ureters and urethra (the tube that carries urine out of the body). This allows for urination in a more natural way, although some patients may experience incontinence or need to catheterize themselves occasionally.

Ureterostomy

In a ureterostomy, the ureters are surgically diverted directly to the skin's surface, creating a stoma for each ureter. Urine drains directly into an external pouch or bag that must be emptied regularly. This is a simpler procedure than an ileal conduit, but it has a higher risk of complications like kidney infections.

Continent Urinary Diversion

Continent urinary diversions create an internal pouch to collect urine. This pouch, often made from bowel, is then connected to the ureters. The patient empties the pouch by self-catheterization through a small opening (stoma) in the abdomen. This eliminates the need for an external pouch, offering a more discreet and comfortable option.

Cutaneous Ureterostomy

Similar to ureterostomy but involving only a single stoma. This method reroutes both ureters to a single opening in the abdomen, creating a cutaneous stoma through which urine is drained into an external collection device.

Procedure	Description	Advantages	Disadvantages
Ileal Conduit	Uses a segment of the small intestine to create a pouch for urine collection, draining to a stoma.	Relatively straightforward procedure.	Requires an external pouch and stoma care.
Neobladder	Creates a new bladder from bowel tissue, allowing for more natural urination.	More natural urination.	Higher risk of complications, potential for incontinence.
Ureterostomy	Directs the ureters to the skin's surface, creating a stoma for each ureter.	Simpler procedure.	Higher risk of complications (kidney infections).
Continent Urinary Diversion	Creates an internal pouch for urine, emptied via catheterization.	No external pouch needed.	Requires self-catheterization.
Cutaneous Ureterostomy	Single stoma for both ureters.	Simpler than separate ureterostomies.	Potential for complications due to single drainage point.

What Replaces a Bladder When Removed?

When a bladder is surgically removed (a procedure called a cystectomy), it needs to be replaced to manage urine. The method used depends on several factors, including the patient's overall health, the reason for bladder removal (often bladder cancer), and the surgeon's preference. There isn't one single "replacement," but rather several options designed to divert urine from the body.

Ileal Conduit (Urinary Diversion)

This is a common urinary diversion procedure. A segment of the small intestine (ileum) is surgically removed and reshaped into a small pouch. One end of this pouch is connected to the ureters (tubes that carry urine from the kidneys), and the other end is brought out through an opening in the abdomen called a stoma. Urine drains into a pouch attached to the stoma, which the patient must empty regularly.

Neobladder (Orthotopic Neobladder)

A neobladder is a surgically constructed bladder created from a section of the bowel (usually the intestine). This new bladder is connected to the ureters and urethra (the tube that carries urine out of the body). This allows for urination in a more natural way, although some patients may experience incontinence or need to catheterize themselves occasionally.

Ureterostomy

In a ureterostomy, the ureters are surgically diverted directly to the skin's surface, creating a stoma for each ureter. Urine drains directly into an external pouch or bag that must be emptied regularly. This is a simpler procedure than an ileal conduit, but it has a higher risk of complications like kidney infections.

Continent Urinary Diversion

Continent urinary diversions create an internal pouch to collect urine. This pouch, often made from bowel, is then connected to the ureters. The patient empties the pouch by self-catheterization through a small opening (stoma) in the abdomen. This eliminates the need for an external pouch, offering a more discreet and comfortable option.

Cutaneous Ureterostomy

Similar to ureterostomy but involving only a single stoma. This method reroutes both ureters to a single opening in the abdomen, creating a cutaneous stoma through which urine is drained into an external collection device.

Procedure	Description	Advantages	Disadvantages
Ileal Conduit	Uses a segment of the small intestine to create a pouch for urine collection, draining to a stoma.	Relatively straightforward procedure.	Requires an external pouch and stoma care.
Neobladder	Creates a new bladder from bowel tissue, allowing for more natural urination.	More natural urination.	Higher risk of complications, potential for incontinence.
Ureterostomy	Directs the ureters to the skin's surface, creating a stoma for each ureter.	Simpler procedure.	Higher risk of complications (kidney infections).
Continent Urinary Diversion	Creates an internal pouch for urine, emptied via catheterization.	No external pouch needed.	Requires self-catheterization.
Cutaneous Ureterostomy	Single stoma for both ureters.	Simpler than separate ureterostomies.	Potential for complications due to single drainage point.

What happens after a bladder is removed?

After a bladder is removed, a procedure called a cystectomy, a surgeon will need to create a new way for the body to eliminate urine. There are several options depending on individual factors like overall health, the extent of the cancer (if applicable), and patient preference. The most common methods involve creating a new urinary diversion. This involves rerouting the ureters (tubes that carry urine from the kidneys to the bladder) to a different location where urine can be eliminated. One option is a ileal conduit, where a section of the ileum (small intestine) is used to create a pouch that collects urine, which then exits the body through a surgically created opening in the abdomen called a stoma. This requires a urostomy appliance to collect the urine. Another option is an orthotopic neobladder, where a section of intestine is surgically constructed to function as a new bladder, allowing for urination through the urethra. This offers a more natural way of eliminating urine, but it's not suitable for all patients. A less common option is a cutaneous ureterostomy, where the ureters are diverted directly to the skin, creating a stoma on each side of the abdomen. This requires two separate ostomy appliances. The choice of method is a crucial decision made in consultation with the surgical and urology teams, considering the patient’s individual circumstances and preferences to maximize quality of life post-surgery. Recovery involves several weeks of healing and adjustment to the new system, with ongoing medical support and potentially rehabilitation to manage any complications.

What are the different types of urinary diversions?

There are several types of urinary diversions used after bladder removal, each with its own advantages and disadvantages. The most common are the ileal conduit, the orthotopic neobladder, and the cutaneous ureterostomy. The ileal conduit creates a pouch using a segment of the small intestine to collect urine, which then exits the body through a stoma. This is a relatively straightforward procedure but requires the use of an external ostomy appliance to collect the urine. In contrast, the orthotopic neobladder involves constructing a new bladder using a section of intestine, allowing for urination through the urethra, mimicking the natural process. This offers a higher quality of life for many patients but requires a more complex surgical procedure and is not always feasible. The cutaneous ureterostomy is a simpler procedure than a neobladder, but it involves bringing the ureters directly to the skin's surface, resulting in two separate stomas that require individual ostomy appliances. Other, less common options may also be considered, such as a Indiana pouch or a mainz pouch, which are variations on the neobladder approach aimed at improving functionality and reducing the risk of complications. The choice of diversion is determined by a multitude of factors, including the patient's overall health, the extent of the surgery, and the surgeon's recommendations. A thorough discussion with the surgical team is vital to understand the implications of each option.

How long is the recovery process after bladder removal?

The recovery process after bladder removal (cystectomy) is significant and variable, depending on several factors, including the type of surgery performed (open versus minimally invasive), the presence of other medical conditions, and the individual's response to surgery. The initial hospital stay typically lasts several days to a couple of weeks, during which time the patient will be monitored for complications such as infection, bleeding, or bowel issues. Pain management is a crucial aspect of early recovery. Once discharged, the patient will need to continue with a course of physical therapy and potentially occupational therapy to help regain strength and mobility. The healing process for the surgical site can take several weeks, with gradual improvement in comfort levels. Learning to manage the urinary diversion is a critical part of recovery, involving instruction on stoma care (if applicable), appliance changes, and potential complications. The time it takes to adapt to the changes in elimination and to regain a sense of normalcy can vary considerably, with some patients feeling well enough to resume normal activities within a few months, while others may require longer-term support and rehabilitation. Regular follow-up appointments with the surgical and urology teams are crucial to monitor healing and address any concerns. The entire process is often a journey of adjustment, requiring patience and commitment.

What are the long-term implications of bladder removal?

The long-term implications of bladder removal depend heavily on the specific type of urinary diversion used and the individual's overall health. Patients with an ileal conduit will need to manage a stoma and wear an ostomy appliance for life. This requires regular maintenance and vigilance to prevent complications such as leakage, skin irritation, and infection. Patients with a neobladder may experience issues such as incontinence, urinary tract infections (UTIs), or the need for intermittent catheterization. Regardless of the diversion type, patients may experience changes in bowel habits, sexual function, and body image. Regular check-ups are vital to monitor for complications such as kidney stones, strictures (narrowing of the urinary tract), and cancer recurrence (if cancer was the reason for the removal). Psychological support is often beneficial to help patients adjust to the changes in their lives. Patients should maintain a healthy lifestyle, including a balanced diet, regular exercise, and adequate hydration to promote overall well-being and minimize potential complications. Long-term management also involves a strong partnership between the patient and the medical team, allowing for prompt identification and management of any arising concerns. The long-term outlook is generally positive for many patients, with appropriate medical care and supportive lifestyle choices.