If a radical cystectomy is necessary, a person also needs urinary reconstruction surgery. To perform this procedure, the surgeon uses a segment of the intestine to create a new avenue through which urine can empty from the body. To help you maintain urinary function without a bladder, our surgeons can use one of several reconstructive techniques.
Urologic surgeons at NYU Langone are highly experienced in performing all types of urinary reconstruction. They are pioneers in minimally invasive reconstructive surgery and have the most experience among specialists in New York City using this innovative technique.
Regardless of the surgical approach, support services are available to people who must adapt to changes in urination after these procedures.
Ileal Conduit Surgery
During creation of an ileal conduit, the doctor removes a short section of the small intestine, the long tube that helps digest food. He or she uses the intestine to create a conduit, or channel, that connects the ureters to a surgically created opening in the abdomen called a stoma. The ureters are tube-like structures that carry urine from the kidneys to the bladder.
After the surgery, urine passes from the kidneys, into the ureters, through the conduit, and out the stoma into a plastic receptacle called a urostomy bag or pouch. The pouch is worn on the outside of the body, underneath clothes, where it discreetly collects urine.
The urostomy pouch is emptied three or four times a day. Our nurses and physicians can help you learn how to care for the stoma and use the urostomy pouch.
If a person is healthy enough for more extensive surgery, a doctor may be able to create a new bladder, known as a neobladder. People who have a tumor that has not spread to the urethra and who are in good health may be candidates for this surgery.
To create a neobladder, doctors use a segment of the small intestine that is three to four times longer than the segment needed to create an ileal conduit. The neobladder is attached to the ureters and the urethra, the tube that carries urine to the outside of the body. For this reason, the urethra needs to be intact for this procedure.
A neobladder gives you the ability to urinate without wearing a urostomy pouch. Our physicians and nurses can teach you how adjust to the new sensations that tell you when to urinate. They can also help you learn how to adjust to complications associated with a neobladder, such as urine leakage or the inability to empty the bladder completely.
Catheterizable Reservoir Surgery
People who are not candidates for a neobladder surgery but wish to avoid a urostomy pouch may be eligible for catheterizable reservoir surgery. In this procedure, doctors use tissue from the intestines to create a reservoir, which a small pouch inside the body, that collects urine. This pouch is connected to the ureters and to a small stoma in the abdomen.
The reservoir needs to be emptied every few hours by passing a catheter, a thin, hollow tube, through the stoma. At NYU Langone, surgeons often create the stoma in the belly button to make the opening less visible. Our nurses and doctors can help you learn how to care for the stoma and empty the reservoir.