Some individuals suffer from bladder conditions that necessitate its removal and the transplantation of a new bladder. How is bladder transplantation performed? Dr. Ashraf Alzaid, Consultant in Kidney and Urological Oncology Surgery, Infertility, Andrology, and Reproductive Medicine, explains the steps and details.

How is bladder transplantation performed?

Bladder transplantation, or neobladder reconstruction, is a surgical procedure in which a new bladder is created using a portion of the intestine. This procedure is performed after the original bladder is removed due to a medical condition, and the new bladder is designed to store urine and allow for its expulsion when needed. The procedure involves the following steps:

• Removal of the bladder and lymph nodes in the pelvic region.
• A section of the intestine, approximately 45 to 60 cm in length, is shaped into a spherical form resembling a natural bladder.
• Connecting the new bladder to the ureters and urethra.

Preparations before bladder transplantation

Certain instructions must be followed before undergoing the procedure, including:

• Relying on fluids only for two days before the surgery.
• Fasting from food and drinks the night before the surgery.
• Informing the doctor about any medications, vitamins, or supplements the patient is taking, as some may need to be discontinued before the surgery.

What happens after bladder transplantation?

Following bladder transplantation, the doctor expects the following:

• Urine flows from the kidneys through the ureters into the bladder, but it may take some time for the patient to learn how to empty the bladder naturally.
• The patient will need to use a urinary catheter for several weeks after the surgery to help empty the bladder.
• The intestinal tissue used to create the bladder will continue to secrete mucus, which appears as thick white discharge in the urine, requiring specific fluids to be passed through the catheter to flush the bladder.

Why is bladder transplantation performed?

Bladder transplantation is performed when the bladder is affected by a medical condition that impairs its function, such as:

• Bladder cancer.
• Neurological diseases affecting the nerves that supply the bladder.
• Urinary incontinence that does not respond to other treatments.
• Congenital bladder abnormalities that cannot be repaired.
• Bladder injury that affects its function.

Who are the suitable candidates for bladder transplantation?

Bladder transplantation is not suitable for all cases. The doctor will decide to proceed with the surgery in the following situations:

• The patient does not want to use a urine collection bag.
• Bladder cancer patients with a low likelihood of cancer recurrence.
• Bladder cancer that has not affected the urethra.
• Candidates must not have chronic gastrointestinal diseases, such as Crohn’s disease, nor have undergone previous gastrointestinal surgeries.
• Good kidney function.
• No prior radiation therapy in the pelvic area, and the patient does not want to undergo this type of treatment.
• The patient’s ability to use and train with a urinary catheter after surgery.

Complications of bladder transplantation

Like any other surgery, bladder transplantation has potential complications, including:

• Bleeding.
• Infection.
• Urine leakage.
• Urine retention.
• Vitamin B12 deficiency.
• Imbalance of salts and minerals in the body.

How to live with the new bladder?

It takes some time for the patient to gain good control over urination after bladder transplantation, as the bladder needs to stretch and the surrounding muscles need to regain strength. The patient may need around 6 to 12 months to learn how to control urination during the day, and longer for nighttime control. It is important to note that the patient will need regular follow-up visits to the doctor during this period to monitor the condition of the bladder.