Bladder cancer is fast growing and doctors may have to surgically remove the organ.  That can mean a patient must wear an outside bag to take care of the bladder's work.  But advanced techniques are giving some patients a chance at a more normal life.

Removal of the bladder means the patient no longer has a means to store urine until it is eliminated from the body. Salem says there are three types of reconstruction that can be performed. One procedure, called an ileal conduit, involves connecting the kidneys to a small sac made from a section of intestine. The sac is also connected to an opening in the skin (stoma), where the urine collects in a small bag.

In another option, called a continent diversion, a valve is created in the newly created sac. The urine is held inside the sac until a catheter is placed into the stoma and valve, allowing the urine to drain out.

The third option for bladder reconstruction is called a neobladder. The neobladder is also made from a loop of intestine. In this case, the section of intestine is cut open, flattened, then sewn into the form of a pouch. The ureters from the kidneys are attached to one end of the neobladder and the urethra is attached to the other. The neobladder functions much like the original bladder, holding urine until it is eliminated through the urinary tract.

Traditional bladder removal requires a very large incision running from below the belly button to the pelvic bone. Although still considered to be the gold standard, the procedure is associated with a significant amount of blood loss and risk for complications. In fact, researchers estimate up to 50 percent of patients having open surgery for bladder cancer experience some type of complication. Salem uses a surgical robot to remove the bladder with a smaller incision, leading to less blood loss. For a man, the robot also helps the surgeon remove the bladder with less risk of damage to the nerves that control erection.

The neobladder takes the place of a bladder, but doesn’t function quite the same. Initially, patients are incontinent. In addition, the body no longer has the bladder muscle walls to expel urine. So pelvic exercises must be practiced every day to develop different muscles to hold and control the flow of urine from the neobladder. After surgery, patients need to urinate about every two hours during the day and every three hours at night. Once patients are able to stay dry, the time limits can gradually be increased. Salem says it can take up to six months for a patient to develop control over urine flow after reconstruction with a neobladder.

For information about the Neobladder, go to the United Ostomy Association, Inc.