Bladder Reconstruction for Cancer or Trauma

The bladder can be surgically reconstructed based on whether the whole bladder or part of the bladder is surgically removed and if the urethra or bladder neck is all scarred or has cancer.

If the whole bladder is removed for cancer, a new bladder can be made from the small bowel. This can happen at the same time as the cancer surgery. To construct a bladder, 60 to 70 cm (3 feet) of small bowel is opened up and sewn together into a spherical bag. The new bladder is then sewn to the urethra. While the neo-bladder is healing, the urine is typically drained by 2 bladder catheters and 2 stents in the ureter.

After 3 weeks, a bladder X-ray is performed to confirm that it is well healed. Catheters are then removed and the patient is instructed how to void. The new bladder is just a floppy urine bag, and thus can only empty by straining the abdominal muscles. Such small bowel pouches are often called “Hautmann” or “Studer” pouches.

If part of the bladder is removed, the bladder can be reconstructed by augmenting the bladder with small bowel or the right colon. Sometimes, the urethra or bladder neck is severely scarred or there is cancer in the urethra. In these cases, a catherizable channel of bowel can also be brought to the navel or abdominal wall. This constructed channel is called the Indiana Pouch or the Mitrofanoff procedure.