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Wednesday, April 16, 2014
Bladder removal & rebuilt
1. After you have your bladder is removed & new bladder is put in and you heal can you live a normal life? 2. How long does the NEW bladder last? 3. Can the body reject the new bladder made of your small bowel? 4. By using your bowel does that affect anything in bowel? 5. Does your prostate have to be removed to and if so why? 6. Will you get the urge to pass urine like when you did before it was removed? Thanks.
As I understand from your email, you are referring to a new bladder created using small bowel (known as neobladder). Most patients with a neobladder are able to learn how to control their urination similar to their original bladder which involves appreciating the urge to urinate, though the urge might not be absolutely same as before with the original bladder. Some patients may have difficulty in completely emptying their bladder and may require to empty their bladder at periodic intervals with a catheter (this is fairly simple and can be taught to the patient). The other small possibility is variable degrees of of inability to control urination (incontinence). With advancing experience with this surgery over the past several years, most patients do very well and have a good quality of life.
The body does not reject this bladder as it is your own tissue. The removal of the prostate is dictated by the primary indication for which the bladder removal is done. The prostate is usually removed along with the bladder when the surgery is done for bladder cancer. Even then not all patients with bladder cancer can have the neobladder surgery. The surgeon has to document absence of active tumor in the vicinity of the opening of the urethra where the new bladder will be attached before proceeding with a neobladder surgery.
What is important to note is that a neobladder needs to be monitored and followed up regularly for development of possible complications which can include stones, infections and rarely tumors in the long term. A neobladder will work pretty well as long as there is an absence of development of any complications, which can be monitored and managed with regular follow up by your urologist. Overall, I feel that a neobladder does provide a good quality of life to a patient who requires removal of his/her bladder.
I understand that this information might not be comprehensive but hope it provides a fair overview of the procedure.
Krishnanath Gaitonde, MD
Assistant Professor of Clinical Urology
College of Medicine
University of Cincinnati