Your surgeon might make you a new bladder (neo bladder) from a piece of your bowel. This means you pass urine the same way as you did before.
The surgeon takes away your old bladder in the same operation. This is called a cystectomy.
Who can have bladder reconstruction?
A bladder reconstruction is not suitable for everyone. You might have this type of surgery if:
- you're at low risk of your cancer coming back
- your cancer didn't affect your urethra
- your bowels are working well and aren't affected by any other problems, such as Crohn's disease or previous bowel surgery
- your kidneys are working well
- you haven’t had and won’t be having radiotherapy to your pelvic area
This operation is more complicated than other types of surgery for invasive bladder cancer. Some people need further surgery to correct problems afterwards.
You have this operation while you’re asleep so you will have a general anaesthetic. The operations takes between 2 and 6 hours.
There are several ways of doing this operation. Usually, the surgeon uses part of your small bowel to make a new bladder. They then sew on to the new bladder:
- the tubes that carry urine down from the kidneys (the ureters)
- the remaining part of the tube that carries urine out of your body (the urethra)
Once healed your urine flows down the ureters as normal and collects in the pouch forming your new bladder.
After your bladder reconstruction
When you wake up from surgery you’ll have a lot of tubes attached to your body. Don’t worry this is to help in your recovery. These tubes will gradually get less as you recover and prepare to go home.
You’ll be in hospital for between 1 to 2 weeks after this operation.
Your surgeon will leave a catheter in place for several weeks. This allows your urine to drain until the joins of your new bladder heal.
A few weeks after you go home you’ll come back into hospital for a day or so. Your doctor will check your new bladder isn’t leaking from the joins. If it isn’t they take out the catheter. You then learn how to empty your new bladder.
Emptying your bladder
When you want to pass urine, you hold your breath and push down into your tummy (abdomen). It’s a bit like pushing to open your bowels, but you use the muscles closer to the front of your tummy instead of those near your back passage. You might hear this called the Valsalva manoeuvre.
You have to remember to go to the toilet and do this regularly. You won't have the nerve supply that used to tell you when your bladder is full. It will feel different to how it did before.
At the start, you will need to empty your new bladder more often as it learns to stretch and fill with different amounts of urine. It can take a little while for your bladder to stretch.
It's not uncommon to leak urine from your new bladder (be incontinent) especially at night when you're asleep. It can be difficult to learn to pass urine naturally, so you will have to regularly put a catheter into the new bladder to drain it.
If your cancer comes back
Bladder cancer might come back in the urethra. If it does, you have an operation to remove the urethra and make an opening on your tummy wall (stoma). This means your urine is collected outside your abdomen (urostomy).