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 with the help of an 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 the stoma, which is an abdominal opening. Another method is to sew the pouch to the 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 incontinent 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.

Some additional complications 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 make urine draining difficult with 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 and 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 a 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 is 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.

Urinary Bladder Surgery