What Happens During Reconstructive Bladder Surgery

Removal of the urinary bladder means that urine produced by the kidneys will need to be stored and moved out of the body in a new way. The creation of a new place for urine to be stored and a way for it to leave your body is called reconstructive surgery. Your surgeon performs reconstructive surgery at the same time that you have your bladder removed. There are 2 main types of reconstructive surgery that can be performed:

  • Incontinent diversion. This is also called a urostomy. After this type of surgery, you no longer urinate the way you once did. You wear a bag on the outside of your body to collect urine.

  • Continent urinary diversion. This surgery creates a new bladder for you so that you can control when the urine leaves your body and do not have to wear a bag. There are 2 main types of this surgery. One type is cutaneous continent diversion, which requires that urine be drained though a hole in your abdomen called a stoma. This is done with a small plastic tube, called a catheter, several times a day. The other type is orthotopic neobladder, which is the creation of a new bladder that is emptied via your urethra the same way you did before surgery.

What happens during a urostomy

Your doctor does this surgery at the same time you are having your bladder removed by a radical cystectomy. This procedure is also called an ileal conduit procedure. For this procedure, your doctor takes a piece of your intestine and connects it to your ureters to direct urine through a small opening in your abdomen called a stoma. The urine passes out of the opening into a plastic bag that is attached to your skin. You then empty urine from the bag several times a day.

What happens during urinary diversion

There are 2 main types of urinary diversion:

  • Cutaneous continent diversion 

  • Orthotopic neobladder

What happens during cutaneous continent diversion

During surgery, your doctor takes a piece of your intestine and connects it to your ureters to create a new path for your urine to flow. The urine is directed to a hole in your abdomen called a stoma. Your surgeon creates a valve that allows you to drain the pouch several times a day. You do this by inserting a tube, called a catheter, through an opening in your abdomen. The opening is often located near the belly button. Or it may be at another convenient place on your abdomen. The catheter drains urine out of the pouch into a container. You can then dispose of the urine in the toilet. Many people prefer this approach because they don't need to wear a urine collection bag on the outside of their body, as people would if they had a urostomy.

What happens with the creation of a neobladder

You can only have this type of surgery if your urethra was not removed during the surgery.

Your surgeon removes a piece of your intestine and creates a sac to hold urine. The new sac is called a neobladder or new bladder. It attaches directly to your ureters from the kidneys and to your urethra. With this approach, you can pass urine through your urethra, just as you did before the surgery. Compared with other reconstructive surgeries, this type most closely resembles your normal urinary system. Many people who have a neobladder say they feel the same urge to urinate as they did before surgery. It may take you awhile, though, to learn to recognize the sensations that mean you need to void. Urine control does not come immediately following the removal of your catheter. You will be given information on the routine you should follow to help train your new bladder.

While the completion of your surgery will bring relief to you and your loved ones, it may also awaken new concerns about how to live with the surgical changes and the impact of a cancer diagnosis. Be certain to ask your medical team for follow-up resources that will help you and your family manage not only the physical effects of the cancer treatment, but also the mental and emotional changes.