Who is Artificial Bladder Applied to? Artificial Bladder Surgery

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Artificial bladder is the compulsory removal of the urinary bladder due to cancer, and the re-bladder is made using the patient’s own intestine.

What is Artificial Urinary Bladder (Bowel Bladder)?

Artificial bladder is the name given to the organ that results from the obligatory removal of the urinary bladder for cancer or any other reason, by using the patient’s own small intestine, and making it into the bladder.

We can call it bowel bladder or orthotopic bladder. In this operation, ureter tubes are connected to the neobladder separately. The urethral tube is also connected to the normal external urinary tract.

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Is There an Alternative To Artificial Bladder?

When bladder cancer is first detected, the first treatment is with TUR-T surgery. After the pathology result is obtained, it is decided what path to follow according to the tumor size, extent and degree.

If there is muscle involvement or high-grade widespread and unresponsive to BCG treatment, radical cystectomy and new bladder methods that will replace the bladder are explained to the patient. There are basically 3 methods.

The first is an artificial bladder or orthotopic bladder (neobladder from the bowel); Approximately 40-45 CM of intestinal part is taken from the ileum part of the small intestine with its veins, turned into a bladder, and the outer urethra, which we call urethra, is connected to one side of the upper urinary tract.

The second is the ileal conduit (ileal loop); Again, instead of the removed bladder, a piece of approximately 15 cm from the intestine is taken with its veins and the upper urinary tract is connected at one end.

The other end of the intestinal part taken is brought to the abdomen, the lower right part of the belly, and the patient urinates from this area into the bag and the bag is emptied at regular intervals.

mesane taşı nedir

When bladder cancer is first detected, the first treatment is with TUR-T surgery.

After the pathology result is obtained, it is decided what path to follow according to the tumor size, extent and degree.

If there is muscle involvement or high-grade widespread and unresponsive to BCG treatment, radical cystectomy and new bladder methods that will replace the bladder are explained to the patient. There are basically 3 methods.

The first is an artificial bladder or orthotopic bladder (neobladder from the bowel); Approximately 40-45 CM of intestinal part is taken from the ileum part of the small intestine with its veins, turned into a bladder, and the outer urethra, which we call urethra, is connected to one side of the upper urinary tract.

çıkarılan mesanenin yerine bağırsaktan yaklaşık 15 cm lik bir parça damarlarıyla birlikte alınıp bir ucuna yukarı idrar yolları bağlanır. Alınan bağırsak parçasının diğer ucu karın bölgesine göbeğin sağ alt kısmına getirilir ve hasta idrarını bu bölgeden torbaya yapar ve torba belli aralıklarla boşaltılır.

The second is the ileal conduit (ileal loop); Again, instead of the removed bladder, a piece of approximately 15 cm from the intestine is taken with its veins and the upper urinary tract is connected at one end.

The other end of the intestinal part taken is brought to the abdomen, the lower right part of the belly, and the patient urinates from this area into the bag and the bag is emptied at regular intervals.

Third, ureterosigmoidostomy; After the bladder is removed, the ureteral tubes, the upper urinary tract, are connected to the sigmoid part of the large intestine. The patient performs both large and small ablutions from the same place, namely from the anus.

As for the answer to the question, the alternative to the artificial bladder is the ileal conduit and ureterosigmoidostomy mentioned above. All methods have their own advantages and disadvantages.

Which Patients Is Artificial Bladder Applied?

Especially in bladder cancers that have muscle involvement or do not respond to high-grade common BCG treatment, an artificial bladder is required to replace the bladder after removal of the bladder.

In infections that cause tuberculosis (bladder tuberculosis) or severe bladder loss, it is necessary to rebuild the bladder. In head traumas or spinal cord injuries, the capacity of the urinary bladder decreases nervously, and the patient’s comfort is completely impaired.

In this case, it may be necessary to expand the bladder with the small intestine.

How is Pre-operative Preparation for Artificial Bladder?

Since patients require preoperative preparation, they are admitted to the hospital one day before the operation. He only takes liquid food and enema 3 times a day.

On the morning of the surgery, we have current routine laboratory findings such as urea creatinine, sodium potassium, and blood sugar. Since the operation will take a long time, compression stockings are worn and taken into operation.

What Other Organs Are Removed While Taking the Bladder?

It is an operation that takes about 4-6 hours. While bladder, prostate and regional lymph nodes are removed in men, bladder, uterus, ovaries and regional lymph nodes are removed in women.

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How Long Will You Stay in the Hospital After Artificial Bladder Surgery?

After the new bladder surgery from the intestine, the patient stays in the hospital for approximately 6-7 days as long as no complications develop. The patient is discharged with a probe and the catheter is taken 18-20 days after the operation, after the necessary examinations and films are taken.

Are There Any Postoperative Complications?

As with any operation, there may be complications depending on the age, additional diseases and general condition of the patient, as well as complications specific to this operation.

In this operation, plenty of stitches are made to turn the bowel into a bladder. In addition, stitches are made to connect both the upper and lower urinary tract to the neobladder.

Leaks, i.e. urine leaks, may occur from these stitches in the early period. However, the majority of them usually improve over time. Renal inflammation and kidney failure, which we call pyelonephritis, may develop.

In addition, there may be complications such as reduction in iron absorption due to the removal of some of the intestines.

Does Artificial Bladder Work Like Normal Bladder?

Although there is no direct urination sensation like in the normal bladder, a feeling of bloating occurs in the abdomen due to the filling of the artificial bladder.

By increasing the intra-abdominal pressure, discharge can be performed by applying some pressure to the abdominal area when necessary.

Ideally, no urine is left inside after urination. Mucus-like materials may come from the urine due to the intestinal release material. Target of making bladder from bowel; No urine is left inside after urinating, urinating comfortably, no incontinence during day and night, infection, especially kidney inflammation.

Prof. Dr. Abdullah ArmağanUrology Specialist

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