Artificial Bladders: Surgical Options for Urinary Retention

Artificial bladder

Hello, I would like to ask about my condition.
I have been experiencing urinary retention for about ten years and have been unable to urinate on my own, so I have been using a catheter.
Due to frequent infections, I experience inflammation every 2-3 months, and I have 3-4 episodes of inflammation each year, sometimes accompanied by pyelonephritis.
Because of this, my doctor has recommended surgery to create a stoma using a segment of my intestine to divert urine from my bladder.
This is the only way to protect my kidneys.
Do I really need to undergo this surgery? Are there any alternative options? If I do have the surgery, what potential complications should I expect? I look forward to your response.

Ru Ru, 30~39 year old female. Ask Date: 2009/07/06

Dr. Xu Weikai reply Urology

Hello, due to the complexity of your question, I took a few days to consider a way to respond that you can understand.
An artificial bladder is typically created using a portion of the small intestine (approximately 40-60 centimeters), which is surgically shaped and connected to the urethra and ureters.
The surgery usually takes over 6 hours and is considered a major operation.
After training, the artificial bladder can allow for natural urination and can hold approximately 600-900 cc of urine, making it most commonly used after bladder cancer surgeries that involve resection.
Post-surgery, training is generally required.
In the initial three months, the intestine will still secrete intestinal fluid, which can be sticky and often leads to blockages, necessitating bladder irrigation to flush out the mucus from the new bladder.
Typically, during the first two weeks post-surgery, several irrigations are needed daily, and while the secretion of mucus will gradually decrease, it is challenging to eliminate it completely.
This is a common early complication.
Additionally, a small number of patients may experience poor contraction of the new bladder, making it difficult to fully empty, which can hinder the intended outcomes of the surgery.
This is also a consideration.
Of course, the risks associated with the surgery are relatively high, given the lengthy duration of the procedure and the associated anesthesia/surgical risks.
As for alternative options, creating a stoma in the lower abdomen connected to a drainage tube can help reduce the risk of infection.
Proper care of the urinary catheter to minimize infection is the simplest approach, but it requires careful attention.
If there are any areas that need further clarification, please feel free to ask, and we can discuss and explore further.

Sincerely,
Dr.
Hsu Wei-Kai
Director of Urology, Taitung Hospital, Department of Health, Executive Yuan

Reply Date: 2009/07/06

More Info

When considering surgical options for urinary retention, particularly in cases where patients have been relying on catheterization for an extended period, it is essential to evaluate the underlying causes and the potential benefits and risks of surgical interventions. In your situation, where you have experienced urinary retention for about ten years and have had recurrent infections, the recommendation for surgery to create a stoma using a segment of your intestine may be a viable option.

Understanding the Surgical Procedure
The procedure you mentioned typically involves using a segment of the small intestine to create a new bladder (also known as an ileal conduit or continent urinary diversion). This new bladder is then connected to the ureters, allowing urine to drain from the kidneys into the new bladder and out through a stoma on the abdominal wall. This approach is often considered when the bladder is no longer functioning effectively, and other treatments have failed.

Necessity of the Surgery
The necessity of this surgery largely depends on the severity of your urinary retention and the frequency of your urinary tract infections (UTIs). If you are experiencing infections every few months, this could indicate that the catheterization is not effectively managing your condition and may be contributing to your recurrent infections. In such cases, surgical intervention may help reduce the frequency of infections and improve your overall quality of life.

Alternative Options
Before proceeding with surgery, it is crucial to explore all possible alternatives. Some options include:
1. Intermittent Catheterization: Instead of a permanent catheter, you might consider intermittent catheterization, which involves self-catheterizing at regular intervals. This method can help reduce the risk of infections compared to continuous catheterization.

2. Medications: Depending on the underlying cause of your urinary retention, medications may be prescribed to help manage symptoms or improve bladder function.

3. Bladder Training: In some cases, bladder training techniques can help improve bladder control and reduce the need for catheterization.

4. Neuromodulation Therapy: This involves using electrical impulses to stimulate the nerves that control the bladder, which can sometimes improve bladder function.

Potential Risks and Complications of Surgery
While surgery can provide significant benefits, it is not without risks. Some potential complications include:
- Infection: Post-operative infections are a risk, especially since you have a history of recurrent UTIs.

- Stoma Complications: Issues with the stoma, such as skin irritation or blockage, can occur.

- Bowel Obstruction: Since the surgery involves the intestines, there is a risk of bowel obstruction.

- Urinary Incontinence: In some cases, patients may experience new or worsening urinary incontinence after the procedure.

- Need for Ongoing Care: You may need to learn how to care for the stoma and manage any associated equipment, such as drainage bags.

Conclusion
In summary, while the surgical creation of a new bladder may be necessary given your history of urinary retention and recurrent infections, it is essential to discuss all available options with your healthcare provider. They can help you weigh the benefits and risks based on your specific medical history and current condition. If surgery is deemed the best option, ensure you are well-informed about the procedure, recovery, and any lifestyle changes that may be required post-surgery. Always feel free to seek a second opinion if you have concerns about the recommended treatment plan.

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