Living without a bladder is medically possible, typically undertaken when the bladder is severely diseased or damaged. While this presents significant adjustments, surgical advancements allow for the creation of new pathways or reservoirs for urine, enabling individuals to maintain a good quality of life. The process involves removing the bladder and establishing an alternative method for the body to store and eliminate urine, requiring a period of learning and adjustment to new routines.
Reasons for Bladder Removal
Bladder removal, known as a cystectomy, is often performed for medical conditions that compromise bladder function or threaten overall health. The most common reason for this surgery is bladder cancer, particularly when it has invaded the muscle wall or is at high risk of spreading. If less invasive treatments are ineffective or cancer recurs, a cystectomy may be necessary to stop the disease from advancing.
Other conditions can also necessitate bladder removal. Severe bladder dysfunction, such as from neurological conditions, can lead to uncontrolled urination or frequent infections. Chronic interstitial cystitis, a painful bladder syndrome, congenital abnormalities, or irreparable trauma to the bladder may also lead to a cystectomy if other treatments are ineffective.
Surgical Options for Urinary Diversion
After bladder removal, urinary diversion creates a new way for urine to exit the body. Surgeons typically use a segment of the patient’s small or large intestine to construct these pathways. The choice of diversion depends on factors including the patient’s overall health, lifestyle, and medical situation.
One common incontinent urinary diversion is the ileal conduit, also known as a urostomy. A small segment of the ileum, part of the small intestine, is surgically detached. The ureters, which carry urine from the kidneys, are connected to one end of this segment. The other end is brought through an abdominal stoma, allowing urine to drain continuously into an external collection pouch.
A continent cutaneous reservoir offers an internal storage solution, providing more control over urine elimination. This method involves creating an internal pouch, often from a section of the large intestine. The ureters are connected to this pouch, and a stoma is created on the abdomen, typically with a valve mechanism to prevent leakage. Patients empty this reservoir by inserting a catheter through the stoma several times a day to drain the urine.
Another internal option is the neobladder, which aims to mimic the original bladder’s function most closely. A segment of the small intestine is reshaped into a spherical pouch and positioned where the bladder once was. This new internal bladder connects to the ureters and the urethra, allowing for more natural urination. While this option provides greater physiological normalcy, some individuals may still need intermittent catheterization for complete emptying.
Daily Life After Bladder Removal
Living with a urinary diversion involves adapting to new routines for managing urine output. This adjustment is a significant part of life after bladder removal.
For those with an ileal conduit, daily life includes regularly emptying and changing the external collection pouch. These watertight pouches are worn discreetly under clothing, requiring emptying throughout the day when they fill with urine. Proper hygiene around the stoma is important to maintain skin health and prevent irritation.
Those with a continent cutaneous reservoir learn to self-catheterize through their abdominal stoma. This involves inserting a small catheter into the internal pouch to drain urine at regular intervals, typically every few hours. This method eliminates the need for an external bag, but requires consistent adherence to the drainage schedule to prevent overfilling and potential complications. Hygiene practices focus on maintaining the cleanliness of the stoma and the catheterization process.
Individuals with a neobladder typically void urine through their urethra, similar to how they did before surgery, by relaxing pelvic muscles and using abdominal pressure. There can be an adjustment period as the neobladder stretches and the patient strengthens the muscles involved in voiding. Some may experience leakage, particularly at night, or find that they occasionally need to use a catheter to fully empty the neobladder. Regardless of the diversion type, managing fluid intake and recognizing the body’s new signals for urine elimination become integrated into daily life.
Adapting to Life Without a Bladder
Adapting to life after bladder removal extends beyond physical urine management. Many individuals experience a period of adjustment as they integrate the changes into their lifestyle. This can include learning new methods of personal care and understanding how clothing may fit differently, particularly for those with an external pouch. With time and practice, these new routines become part of daily life.
The psychological impact of bladder removal can be significant, affecting body image and emotional well-being. Support groups and counseling provide valuable resources for individuals to share experiences and address concerns. Connecting with others who have undergone similar surgeries fosters community and offers practical advice.
Long-term considerations include ongoing medical follow-up to monitor the urinary diversion’s health and overall well-being. While challenges may arise, studies indicate many patients report a favorable quality of life within two years after radical cystectomy and urinary reconstruction. With proper care, support, and adaptation, individuals can return to many previous activities, including work, hobbies, and travel.