It is possible to live without a bladder. While the bladder stores urine, medical advancements offer effective surgical solutions for its removal. These procedures create new ways for the body to manage and eliminate urine, enabling patients to continue with their daily activities.
Medical Reasons for Bladder Removal
Bladder removal surgery, known as a cystectomy, is performed when the bladder is severely diseased or damaged when other treatments fail. The most common reason is bladder cancer, especially when it has invaded the muscle wall or aggressive forms persist after initial therapies. This aims to prevent cancer spread.
Other medical conditions can also necessitate bladder removal. Congenital abnormalities of the urinary system, present from birth, might require a cystectomy to correct impaired bladder function. Chronic inflammatory conditions causing debilitating pain and unresponsive to medical management, such as interstitial cystitis or radiation cystitis, can also lead to bladder removal to improve quality of life. Severe, irreparable bladder trauma may also prompt this surgery.
Methods of Urinary Diversion
After bladder removal, a urinary diversion, a new pathway for urine to exit the body, must be created. Surgeons use segments of the intestines to construct these diversions, ensuring kidneys filter waste and produce urine. Method selection depends on overall health, medical history, and personal preferences.
One common approach is an incontinent diversion, like an ileal conduit. A small segment of the ileum (part of the small intestine) is isolated to create a tube. The ureters, carrying urine from the kidneys, connect to one end of this segment. The other end forms a stoma on the abdominal wall, allowing urine to continuously drain into an external collection pouch worn discreetly. This pouch requires regular emptying.
Another category is continent diversions, offering internal urine storage. Continent cutaneous diversions, such as the Indiana Pouch or Kock Pouch, create an internal reservoir from a segment of the intestine, often the ileum and colon. This pouch is placed inside the abdomen, with ureters connected to it. A stoma is also created on the abdominal wall, but unlike the ileal conduit, it has a valve to prevent continuous leakage. Patients periodically insert a catheter into this stoma to drain the internal pouch, several times a day.
The orthotopic neobladder is a continent diversion that mimics natural urination. A segment of the small intestine is reshaped into a pouch and positioned where the original bladder was. The ureters connect to this new bladder, which is also connected to the urethra. This allows individuals to void urine through their urethra, similar to before surgery. It may require learning new techniques to fully empty the neobladder, sometimes involving gentle abdominal pressure or intermittent catheterization.
Living Without a Bladder
Adapting to life without a bladder involves adjusting to new routines for managing urine and addressing potential physical and emotional changes. Daily management depends on the type of urinary diversion created. For those with an ileal conduit, learning proper stoma care and how to empty and change the external collection pouch is a routine part of daily life. Pouches are typically emptied when about one-third full to maintain a flat profile and are changed regularly, often in the morning before eating or drinking to minimize dripping.
Individuals with continent cutaneous diversions must learn to self-catheterize through their stoma several times a day to empty the internal pouch. This involves inserting a thin tube to drain the accumulated urine. For those with an orthotopic neobladder, retraining the pelvic floor muscles and establishing a regular voiding schedule are important for achieving continence. Some individuals with neobladders might experience urinary leakage, especially at night, and may use pads or require occasional catheterization to ensure complete emptying.
Lifestyle adjustments after bladder removal are generally manageable, and most individuals return to a high quality of life. Hydration is encouraged, with a focus on drinking plenty of water, while sugary beverages might be limited. Physical activity, including exercise and swimming, is often possible once recovery is complete, usually within a few weeks to a few months. Travel is also feasible, though planning for ostomy supplies or catheterization needs is advisable.
Potential challenges include stoma-related complications such as skin irritation around the stoma, or potential urinary tract infections with any diversion type. Emotional adjustments, including body image concerns and the psychological impact of surgery, are also common. Support systems, such as medical follow-up appointments with urologists and ostomy nurses, as well as patient support groups, are valuable resources for navigating these changes. Most people adapt well over time, with studies showing that patients often report their quality of life returning to pre-surgery levels within two years, highlighting the significant improvements in health and well-being that bladder removal can provide for many patients.