Living without a bladder is possible through a cystectomy, a surgical procedure to remove the bladder. This is followed by a urinary diversion, which creates an alternative pathway for urine to exit the body. While this represents a significant medical intervention, individuals can adapt to a new way of managing urinary function and often return to many of their previous activities.
Reasons for Bladder Removal
Bladder removal, or cystectomy, is primarily performed to treat bladder cancer, especially when the cancer has invaded the muscle wall or is high-risk and hasn’t responded to other treatments. This procedure aims to prevent cancer spread and improve long-term survival. Beyond cancer, cystectomy may be necessary for severe non-cancerous conditions unresponsive to other treatments. These include chronic bladder pain (e.g., severe interstitial cystitis), significant dysfunction from neurological conditions (e.g., multiple sclerosis), severe trauma, congenital abnormalities, or complications from radiation therapy.
Urinary Diversion Explained
After bladder removal, a new pathway or reservoir is created for urine, which the kidneys continuously produce and send through ureters. This urinary diversion prevents urine from backing up into the kidneys, avoiding pain, infections, or kidney damage. A urinary diversion is an alternative system to manage urine flow, not a replacement bladder. Surgeons use a segment of the patient’s intestine to construct this new pathway or pouch. The chosen method depends on the patient’s health, reason for surgery, and preferences.
Types of Urinary Diversions
Several methods exist for urinary diversion.
Ileal Conduit
The ileal conduit is the most common incontinent diversion. In this procedure, a small section of the small intestine (ileum) is disconnected, and the ureters are attached to one end. The other end of this intestinal segment is brought through an opening in the abdominal wall, called a stoma, where urine continuously drains into an external collection pouch worn on the body.
Neobladder
Another option is the neobladder, a continent diversion allowing urine to exit through the natural pathway. Surgeons create an internal pouch from intestinal segments, shaping it to resemble a bladder, and connect it to the urethra. Patients learn to empty it by relaxing pelvic muscles and increasing abdominal pressure, though it may require a learning curve to achieve continence and sometimes involves self-catheterization for complete emptying.
Continent Cutaneous Reservoir
A third type is the continent cutaneous reservoir, another continent diversion. This involves creating an internal pouch from intestinal tissue that stores urine inside the body. Unlike the neobladder, this pouch connects to a stoma on the abdomen, often near the belly button. Patients drain this reservoir periodically by inserting a thin tube, or catheter, through the stoma, eliminating the need for an external collection bag.
Adjusting to Life Without a Bladder
Life after bladder removal and urinary diversion involves an adjustment period, yet a high quality of life is achievable. Initial recovery involves a hospital stay of several days to two weeks. Patients learn about their new urinary system, manage discomfort, and receive education on stoma care (if applicable) and diversion management.
Daily management varies by diversion type. Ileal conduit users empty and change their external collection pouch regularly. Neobladder or continent cutaneous reservoir users learn techniques like timed voiding or self-catheterization for internal pouch emptying. Routine care includes hygiene, preventing stoma skin irritation, and managing mucus production from the intestinal segment.
Lifestyle adjustments are common and manageable. Most individuals return to work, exercise, and social activities. Clothing may need slight modifications for an external pouch, though many find their previous wardrobe still fits. Concerns about body image and intimacy can be addressed with available resources and support. Emotional support from healthcare providers and peer groups aids adaptation.