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Urinary Bladder Surgery:
A guide to the procedure, risks and recovery

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1.What is urinary bladder (bladder) surgery?

The urinary bladder is an organ found in the pelvis region. It resembles an empty flexible pouch or sac. The urinary bladder is responsible for storing urine that has been made by the kidneys. Ureters are tubes that are responsible for carrying urine made by the kidneys to your bladder. Urine is stored in the bladder until it leaves your body. When you urinate, bladder muscles enable elimination of the urine by pushing it out through the urethra, which is another tube structure. People who have a healthy bladder can hold urine until they consciously go and urinate. Bladder surgery is required when you have certain conditions that inhibit this process from taking place properly.


There are various urinary bladder problems that can be treated with the help of bladder surgery. These problems include being unable to urinate when you need to or being unable to hold urine until you get time to relieve yourself. Bladder issues can arise from a range of different factors and not all of them need surgery. Bladder surgery can be done solely to treat a bladder problem, or it can be used in conjunction with other types of treatments. It depends on the bladder issue or problems that you are suffering from and how it affects you. For some people, their bladder issue is so severe that bladder surgery is the only viable option.

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2.Why is urinary bladder surgery performed?

Your doctor will first try to treat your bladder problems through medications and other procedures that don’t require surgery. When these do not work, only then bladder surgery will be considered as a treatment option. For some conditions that cannot be treated by medications, bladder surgery is the only option that you have. There are various types of bladder surgeries that enable your bladder to perform its role as it normally should. These surgeries depend on the type of condition that you have and treating the condition that is causing bladder function problems.

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3.Conditions that require urinary bladder surgery

The following are some of the common conditions that require urinary bladder surgery to be performed.

  • Urinary incontinence
  • Cystocele
  • Urinary bladder cancer
  • Stress incontinence
  • Urinary bladder stones
  • Any inflammatory disorder or congenital disability that affects the urinary system like tuberculosis.

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4.Types of urinary bladder surgery

Types of bladder surgery

Bladder augmentation surgery, also called cystoplasty, is for those people who have a tiny bladder that is causing kidney damage to occur. This is because the small bladder is unable to hold a lot of urine and this puts pressure on the kidneys. This surgery is not recommended for people who have bowel-related problems.

Urinary diversion is a surgery that is used when bladder augmentation surgery is not an option due to a damaged bladder. Urinary diversion can be used when the urethra is damaged or when the bladder has to be removed due to a serious issue such as cancer. There are two types of urinary diversion surgeries - incontinent diversion and continent diversion.

Transurethral resection (TUR) is a surgery that is often used for people who have bladder cancer in which cancer has reached the bladder wall. Sometimes, TUR needs to be done twice to ensure no trace of cancer is present after the surgery. In some cases, fulguration might need to be used with TUR whereby the small tumours are burnt.

Radical cystectomy or bladder removal is used in cases where the bladder cancer has become invasive. It can be used in non-invasive bladder cancer that is recurrent too. There are two types of cystectomy - radical cystectomy and partial cystectomy. Which surgery method is used depends on how much of the bladder needs to be removed.

Neobladder reconstruction is also known as orthotopic neobladder reconstruction. It is required when a person has lost their bladder. This surgical procedure is used when your bladder doesn’t function properly, or you have bladder cancer, bladder trauma, have a non-functional bladder, or urinary incontinence.

Bladder suspension surgery is used in cases where the bladder is sagging. Another term used for bladder suspension surgery is bladder neck suspension. It is used to treat severe or moderate stress incontinence. There are four types of surgery - laparoscopic retropubic suspension surgery, open retropubic suspension surgery, sling surgery, and needle bladder neck suspension surgery.

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5.Are you the right candidate for urinary bladder surgery?

Are you the right candidate for bladder surgery?

You might need bladder surgery if the bladder problem is so severe that it is interfering with your daily life. Women who do not want to have any more children are the right candidates for bladder surgery because pregnancy can bring back bladder problems. Your medical history will determine whether you are right for bladder surgery or not. People who have had surgeries and the type of surgery they had will determine whether they can have bladder surgery or not. Your age and lifestyle are two factors that are important when determining eligibility for bladder surgery and the cause of the bladder issue.

Your general health and health problems can help determine whether you are the right candidate for bladder surgery or not. Cost of surgeries can differ depending on the type of bladder surgery that is required. Hence, your financial situation and whether you can cope with what needs to be done post-surgery are also factors to determine whether you are the right candidate. At the end of the day, your doctor will decide if you are the right candidate for bladder surgery. He will carefully evaluate all the factors and discuss the risks, complications, and benefits with you. Only after careful consideration and discussion, you should give your nod.

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6.How do you prepare for urinary bladder surgery?

Your doctor will give you a checklist, so you know what you need to do before bladder surgery. For instance, you will need to stop taking any blood-thinning medicines at least one week before the bladder surgery is scheduled. You need to stop taking aspirin and NSAIDs at least a week before the surgery. Any supplements and medicines that increase the risk of bleeding will need to be stopped before the surgery. For some types of bladder surgeries, medications such as those related to blood pressure and antibiotics may need to be stopped before surgery.

You should follow your doctor’s instructions carefully. Stop taking medicines only if they have advised you to do so. Otherwise, you increase the likelihood of further complications and risks. You might be required to quit smoking altogether because it increases the chances of risks of surgery. Your doctor can tell you to stop consuming other tobacco products, too, as they hinder fast healing. The day before the surgery, you might need to go on a clear liquid diet. Your doctor will recommend which foods you can eat and when your last meal should be before surgery to ensure surgery goes smoothly.

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7.Complications and risks that may arise after urinary bladder surgery

Various complications and risks may arise from bladder surgery. Each type of bladder surgery carries its own set of risks and complications. You don’t need to have these problems, but they are likely to happen after surgery. The following are risks according to the common surgery types.

There are various complications and risks of bladder augmentation surgery and urinary diversion surgery. There can be an increase in bladder stones and kidney stones as a result. There is a risk of complications depending on which part of the stomach or intestine was affected in the surgery. Although this rarely occurs, overstretching can cause the pouch to rupture, causing further risks. If the intestine is caught in the scar tissue from the surgery, bowel obstruction can result. Another possible complication is the presence of mucus in urine. Diarrhoea is another risk of bladder augmentation surgery.

The complications and risks of transurethral resection surgery are as follows. You might have trouble urinating after the surgery. You might experience some bleeding after the surgical procedure. If repeated TUR surgery is performed on a patient then the bladder can become scarred, and this can result in incontinence. Frequent urination might be one of the risks of transurethral resection surgery. Some more complications and risks can arise due to the procedures carried out after the transurethral resection surgery to ensure all the cancer is completely removed and destroyed.

Cystectomy is considered to be a complex surgery, which is why there are many complications and risks associated with it. As a result of the surgery, you can suffer from a heart attack or witness excessive bleeding. There is a chance that you develop an infection or even get pneumonia after the surgery. Due to cystectomy surgery, you can get blood clots too. Some people suffer from dehydration. Some other risks associated with cystectomy are ureter blockage and urinary tract infection. Electrolyte abnormalities and bowel obstruction are complications associated with cystectomy.

Complications and risks of neobladder reconstruction surgery are many. You can have electrolyte imbalances after the surgery. You can suffer from incontinence after the surgery. Another complication that can arise is cancer in the bowel. You can suffer from excessive bleeding after the surgery, and there is a risk of blood clot formation. You can get more prone to infection after the surgery. You can suffer from urine retention problems, or you can have urine leakage problems after neobladder reconstruction surgery. Vitamin B-12 deficiency is another common complication that can happen after the surgery.

Bladder suspension surgery comes with several complications and risks. People often suffer from having difficulty when they urinate after surgery. There is a risk of permanent urinary retention after bladder suspension surgery. Overactive bladder, bladder spasms, vaginal prolapse, and bleeding are common complications of the procedure. Some people have reactions to anaesthesia, while others suffer from blood clots. Abscess, catheter-related infections, injury to urinary tract structures, painful sex, and groin pain are other complications that can occur due to bladder suspension surgery.

Your doctor is the person who is most apt to tell you about the risks and complications that you should be concerned about. Since he is the one who will know everything about your medical history and how you cope with the surgery, he will be more accurate to tell you about what you need to look out for after bladder surgery.

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8.Understanding the urinary bladder surgery procedure

Since there are various types of bladder surgeries, their methods vary. Here is how different bladder surgeries are performed.

Bladder augmentation surgery


The bladder augmentation surgery enables the bladder to store large amounts of urine safely without causing high pressures and urine leakage. Your doctor will check the function and structure of your kidneys and your bladder first. When the surgery is taking place, a part of the stomach or bowel is removed. The top part of the bladder is opened up with the help of incision. The part that was removed from the stomach or the intestine is then sewn on the top part of the bladder. This enables the bladder to become larger so that it can hold the urine produced by the kidneys.

Urinary diversion


Urinary diversion surgery is used to make the urine flow from the bladder to the intestine pouch that has been created to hold urine. The surgeon uses pieces of intestine or stomach to create an artificial bladder. When the new pouch is in place, the ureters are sewn to it. Then another piece of the intestine is used for the creation of a tube. This goes from the pouch to stoma, which is an abdominal opening. Another method is to sew the pouch to urethra instead. Urinary diversion surgery can be of two types - incontinent diversion surgery or continent diversion surgery.

In incontinent urinary diversion surgery, the urine comes out of the stoma immediately as it is made. The stoma is attached to a bag which is placed outside the body and is used to hold the urine. You need to empty the bag when it is filled with urine. In continent urinary diversion, a pouch is created with the intestine, and one end of it is attached to the stoma. At the opening, a one-way valve is created which enables you to put a catheter so you can then drain the urine that is stored in the stoma.

There are some additional complications that can occur later when you have urinary diversion surgery. Urinary diversion can cause parastomal hernia. Another complication is that it can become difficult for the urine to drain if the skin around the stoma becomes narrow. This can cause difficulty for urine draining with the help of a catheter. The tube that is attached to the kidney can be shut due to scar tissue as a result of urinary diversion surgery. This can cause other complications to arise.

Transurethral resection (TUR)


Transurethral resection surgery involves using a resectoscope. A resectoscope is a thin and rigid cystoscope that comes built with a loop made of wire on one end. The resectoscope is put through the urethra into your bladder, and any tissues that seem abnormal are removed with it. Tumours are removed similarly with a resectoscope. These are then sent for testing to confirm if it is cancer or not. If the abnormal tissue or tumour is cancerous, then fulguration can take place whereby the area of the abnormal tissue or tumour is burned away. Another method is to use a laser to destroy the cancer cells in the area.

Cystectomy


There are two types of cystectomy - partial cystectomy and radical cystectomy. Partial cystectomy is when the cancer is not that large is only present in one location. Moreover, this surgery is used when the cancer is on the bladder’s muscle layer. There is a hole that is made in the wall of the bladder. When the cancer is removed, it is closed with stitches. In this surgery, lymph nodes which are found nearby can be removed to ensure the cancer has not spread to them. When you have this surgery, reconstructive surgery is not required since the entire bladder is not being removed.

In a radical cystectomy, the entire bladder is removed during surgery with the help of an incision in the abdomen. Else, laparoscopic surgery can be done, which means fewer incisions and scars. Radical cystectomy is done when the cancer is large, or it is present in several parts of the bladder. Lymph nodes are removed along with the bladder. In women, the uterus, ovaries, a part of the vagina, fallopian tubes, and cervix are removed too. In men, seminal vesicles and prostate are removed during radical cystectomy. Reconstructive surgery needs to be done after radical cystectomy.

Neobladder reconstruction surgery


In this type of surgery, the cancerous bladder is first removed. This can be done with the help of robotic surgery or laparoscopic approach. Else, another way is to use a traditional abdominal incision to remove the cancerous bladder. Then a section from the colon, small intestine, or both is used to create a neobladder. This neobladder is placed in the location of your original bladder. The ureter is then connected to the neobladder on one end and on the other, the urethra is connected to the neobladder. This lets the neobladder function as your new bladder. The urine can now be stored in this neobladder.

Bladder suspension surgery


There are several types of bladder suspension surgery and how they are performed depends on the particular surgery method. The needle bladder neck suspension surgery is performed through the vagina or abdomen. The sling surgery is done using fascia, which means your body tissue taken from the wall of the abdomen. You can use donated tissue as well. In a sling surgery, a man-made material can be used instead. This is used for supporting the bladder neck which is sagging and it supports the urethra too.

Open retropubic suspension surgery consists of making an incision in the stomach area. Your surgeon first locates the bladder after making an incision, and then he pulls the neck of the bladder. He then sews it to the tissue or bone that surrounds it to keep it in place. The bladder neck is sewn with the help of sutures. In laparoscopic retropubic suspension surgery, smaller incisions are made as compared to open retropubic suspension surgery. The healing times may be much faster, as well.

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9.How do you recover from urinary bladder surgery?

How do I recover from bladder surgery?

You may need to stay in the hospital for up to 10 days after bladder augmentation surgery. It can take you up to 4 months to recover completely from the surgery. Most people are cured with this surgery. When you get cystectomy done, you might need to stay in the hospital for about a week. When you get bladder suspension surgery done, then it depends on the specific method used to perform surgery. Some procedures can be done as an outpatient. Any bladder surgery that is done by making an incision through the abdomen takes more time to recover when compared to procedures done through the vagina.

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10.Precautions to take after bladder surgery

You should avoid strenuous activities such as lifting a lot of weight and doing intense workouts for a month or two after your bladder surgery. It is best to avoid sex for at least a month after bladder surgery. You might need at least a month to resume normal daily activities. In this period, you should avoid driving. You might need to take leave from your work to heal and recover. Bathing is also not a good idea for a few weeks after surgery. Women should avoid using tampons for at least six weeks after surgery. Vaginal douches should not be used during this period either.

Precautions will specifically depend on the bladder surgery that you go through. Hence, speak to your doctor about what you can safely do and what you should avoid after bladder surgery. Recovery takes time with any bladder surgery, and so you should take time off to heal and recover well. You should try not to put any stress on the bladder area. For women, they should stop doing any activity that puts pressure on the vaginal area too. You should be mindful of how you perform daily activities to ensure you are not putting unnecessary pressure in your abdomen region.

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11.Bladder Surgery FAQs: All your concerns addressed.

Q.   Will I experience change in sex life as a result of cystectomy?

  1. Yes, there are chances. Cystectomy affects men and women differently. Women might find it difficult to have sex because it makes them feel because any changes in the vagina can make them feel discomfort during intercourse. Some women cannot have an orgasm if nerve damage has occurred. For men, they can experience difficulty in having erections, although improvement can be seen over time. For people who have a stoma pouch, you should empty the pouch before you engage in intercourse. You can ask about nerve-sparing techniques with your doctor. You should discuss all your concerns regarding how surgery can affect your sex life with your doctor.

Q.   Why choose Narayana Health Hospital in India for bladder surgery?

  1. Narayana Health is one of the best hospitals in Bangalore with a highly reputed Urology department. When you want to get complex surgeries done such as bladder surgery, then you need the best bladder surgeon. You can find the most experienced and skilled urologists in Bangalore at Narayana Health. There is a range of bladder-related problems that can get treated at this hospital. These include overactive bladder, bladder cancer, urinary incontinence, and stress incontinence. This makes Narayana Health the best urology hospital in Bangalore.

Q.   When does one need bladder removal surgery?

  1. Bladder removal surgery or cystectomy is performed in individuals with bladder cancer. The surgery can also help to treat other conditions like tumours in the pelvis or interstitial cystitis that doesn’t respond to other treatments. Less invasive options may be used if bladder cancer is still in its early stages.
    Before going for bladder surgery, the patient can talk to the doctor and find out all about their options. The surgical procedures that need to be followed will depend on the overall health of the patient, the stage of cancer, the area where cancer has formed, and whether the cancer is recurring.

Q.   What to expect after cystectomy?

  1. The patient is put under general anaesthesia before the bladder is surgically removed. Due to the effects of the anaesthesia, the patient may feel groggy after waking up following the surgery. To manage the pain from surgery, the doctor will likely prescribe narcotics or epidural medications.
    The patient will be moved from the post-operative room to a regular hospital room once their condition stabilises. The care team will assess the new system for urine evacuation during this time. The person will be discharged from the hospital when the new urine evacuation system starts functioning correctly. The healthcare team will explain the person and their caregiver about using the system.
    After being discharged from the hospital, it may take several weeks to recover. On average, people can resume their normal activities in about four to six weeks.
    The first few weeks after the surgery are crucial for recovery. Proper follow-ups with the doctors are necessary to identify any complications and prevent it. Moreover, the follow-up visits will help the person to check with the doctor about any problems they are facing.

Q.   Are there any risks associated with the surgery?

  1. There is always a risk associated with any form of surgery. Some of the risks and complications that may arise from bladder removal surgery are:
    • Negative reaction to the anaesthesia
    • Bleeding or infection at the site of surgery
    • Urine leakage
    • Blood clots
    • Pouch stones
    • Damage to surrounding organs or tissues
    • Blocked urine path
    • Sexual issues, such as erectile dysfunction, inability to orgasm, etc.

Q.   What is bladder suspension surgery and who needs it?

  1. Bladder suspension surgery is carried out to put a sagging bladder back into its normal position. It is used to treat stress incontinence. This condition causes you to leak urine whenever some activity like coughing, sneezing or running puts pressure or stress on the bladder. Women may suffer from stress incontinence when they lose muscle tone along the pelvic floor due to childbirth or from hormonal changes that come with menopause.
    There are non-invasive treatments as well for stress incontinence, such as medications, electrical stimulation and Kegel exercises, but they are recommended only if the condition is moderate or less severe. For more severe cases of stress incontinence occurring from childbirth, menopause, surgeries, muscle problem in the bladder and urethra, bladder suspension surgery may be the only option.
    It is important to note that most surgery-failures occur due to incorrect diagnosis. Therefore, before considering bladder suspension surgery, it is recommended to get a second opinion.

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