Undergoing bladder removal, medically known as a cystectomy, is a significant surgical procedure. This surgery is considered when severe bladder conditions necessitate its removal for a patient’s health. While a profound change, individuals often adapt well, achieving a good quality of life post-recovery.
Reasons for Bladder Removal
Bladder removal primarily addresses serious medical conditions compromising bladder function or threatening overall health. The most common reason is bladder cancer, especially when it has invaded the muscle wall or when high-grade, non-muscle invasive cancer has not responded to other treatments. Removing the bladder can prevent cancer spread and improve long-term survival.
Beyond cancer, cystectomy may be necessary for severe non-malignant conditions unresponsive to less invasive therapies. Chronic interstitial cystitis, causing persistent bladder pain and urinary urgency, can lead to bladder removal in its most severe, debilitating forms. This is a last resort when pain significantly impacts quality of life and other treatments fail.
Neurogenic bladder dysfunction, resulting from nerve damage affecting bladder control, can also necessitate a cystectomy. It’s considered when conservative treatments can’t manage severe incontinence, recurrent urinary tract infections, or upper urinary tract deterioration. Additionally, some congenital abnormalities, birth conditions affecting bladder structure or function, may require bladder removal if they lead to severe complications like persistent infections or incontinence. Severe bladder trauma, such as from major accidents, may also require removal if damage is irreparable.
Surgical Procedures for Bladder Removal
Cystectomy is the surgical removal of the urinary bladder. Extent of removal depends on the underlying condition and severity. A radical cystectomy involves excising the entire bladder along with surrounding lymph nodes. In men, this often includes the prostate and seminal vesicles; in women, the uterus, ovaries, fallopian tubes, and sometimes part of the vagina may be removed. This comprehensive approach is common for muscle-invasive bladder cancer to ensure all cancerous tissue is removed.
Partial cystectomy, removing only a portion of the bladder, is less common. It’s reserved for specific indications, like a small, localized tumor confined to one bladder area. This allows the remaining bladder to function, though capacity might be reduced.
Surgical approaches include traditional open surgery (larger incision) and minimally invasive techniques like laparoscopic or robotic-assisted surgery. Minimally invasive methods use smaller incisions and specialized instruments, often leading to faster recovery. Regardless of technique, cystectomy is complex, requiring significant recovery and a new method for urine elimination.
Life After Bladder Removal: Diversion Methods
After bladder removal, the body still produces urine, requiring a new pathway for storage and elimination. This is achieved through urinary diversion methods, fundamental to post-cystectomy life. Choice of diversion is tailored to the individual, considering overall health, lifestyle, and surgeon’s recommendation.
One common approach is incontinent diversion, primarily the ileal conduit. In this procedure, a segment of the small intestine (ileum) is detached. One end connects to the ureters (transporting urine from kidneys); the other is brought through the abdominal wall to create a stoma, a small opening. Urine continuously drains through this stoma into an external collection pouch (ostomy bag), worn discreetly under clothing.
Alternatively, continent diversions allow internal urine storage. A neobladder is created using an intestinal segment, connected to the urethra (natural urine exit). This allows individuals to empty their neobladder by relaxing pelvic muscles and increasing abdominal pressure, mimicking natural urination; some may need intermittent catheterization. It aims to mimic original bladder function and eliminates the need for an external appliance.
Another continent diversion is the continent cutaneous reservoir, such as an Indiana Pouch. This method uses an intestinal section to form an internal pouch with a valve. A small stoma is created on the abdomen, but unlike an ileal conduit, urine doesn’t drain continuously. Instead, individuals insert a catheter into the stoma regularly to empty the reservoir. These methods fundamentally redefine urine management, each with distinct requirements.
Living with a Removed Bladder: Daily Life and Adjustments
Adapting to life after bladder removal involves physical and emotional adjustments. Patients learn to manage their specific urinary diversion method, whether emptying an external ostomy pouch or an internal neobladder/continent cutaneous reservoir. This gradual process is supported by healthcare teams providing comprehensive education. Physical recovery involves regaining strength and mobility, with gradual return to normal activities.
Dietary and hydration are important. Adequate fluid intake is encouraged to promote kidney health and prevent urinary tract infections, regardless of diversion type. Specific dietary modifications might be suggested to manage bowel function, especially since an intestinal segment is often used in diversion creation. For individuals with a stoma, meticulous hygiene and skin care around the stoma site are essential to prevent irritation and infection.
Beyond physical aspects, the psychological and emotional impact of bladder removal can be substantial. Adjusting to changes in body image and living with a new bodily function can be challenging. Support groups, counseling, and open communication with healthcare providers and loved ones are beneficial during adaptation. Addressing these emotional aspects is an important part of recovery.
Sexual function may also be affected by bladder removal, particularly radical cystectomy, due to nearby organ removal or nerve disruption. Discussions with healthcare professionals about potential changes and available resources can help address these concerns. Regular medical follow-up monitors for complications, ensures proper urinary diversion function, and checks for original condition recurrence. While adjustments are necessary, many individuals successfully integrate these changes and return to a full, active life.