Our Summary

This research paper discusses a new approach to dealing with lower urinary tract problems in patients who are on dialysis and need kidney transplants. These patients often need surgery to increase and adjust their bladder capacity before they are eligible for a kidney transplant. This usually involves using parts of the intestine in the procedure. However, this can lead to issues like acidosis (too much acid in the body), repeat urinary tract infections, and stone formation, which can cause frequent hospital stays and the loss of the transplanted kidney’s function.

The best material for these procedures would be actual urinary tissue, but it can only be used in a small number of cases. The researchers have been looking at a new approach - transplanting a bladder that has been kept alive with its blood supply, or vascularized bladder transplantation. They managed to do this for the first time in a brain-dead patient. They were able to keep the transplanted bladder alive for 12 hours after the procedure.

But there are challenges. The procedure was done using a robot, which means it may not be easy to repeat in settings where multiple organs are being collected for transplant, or in most transplant centers. There are also questions about whether the benefits of only transplanting the bladder outweigh the risks associated with suppressing the patient’s immune system to prevent it from rejecting the new organ.

However, for patients who need a kidney transplant and also need their lower urinary tract rebuilt, using the same donor’s bladder could be a good option. It could avoid the complications that come with using parts of the intestine, without increasing the risk to the patient’s immune system. The researchers believe that combined kidney and bladder transplants could be the next big thing in abdominal organ transplants.

FAQs

  1. What are the current challenges faced by patients needing a kidney transplant with lower urinary tract problems?
  2. What is vascularized bladder transplantation and how can it benefit patients needing a kidney transplant?
  3. What are the potential challenges in implementing vascularized bladder transplantation in most transplant centers?

Doctor’s Tip

A doctor might tell a patient undergoing bladder surgery to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding heavy lifting or strenuous activities for a certain period of time. Additionally, they may advise the patient to drink plenty of water to help flush out the bladder and prevent urinary tract infections, as well as to perform pelvic floor exercises to strengthen the muscles and improve bladder control. It is important for the patient to communicate any concerns or complications to their doctor promptly to ensure a successful recovery.

Suitable For

Patients who are typically recommended bladder surgery are those who have lower urinary tract problems that cannot be managed with other treatments. This includes patients who have:

  1. Bladder cancer: Surgery may be recommended to remove the cancerous cells and part or all of the bladder.

  2. Overactive bladder: Surgery may be recommended to increase bladder capacity and reduce the frequency and urgency of urination.

  3. Bladder prolapse: Surgery may be recommended to repair the weakened pelvic floor muscles that are causing the bladder to drop into the vaginal area.

  4. Urinary incontinence: Surgery may be recommended to support the bladder and urethra to prevent leakage of urine.

  5. Bladder stones: Surgery may be recommended to remove large or multiple bladder stones that cannot be passed through urine.

  6. Interstitial cystitis: Surgery may be recommended to remove ulcers or scar tissue in the bladder that are causing pain and discomfort.

  7. Neurogenic bladder: Surgery may be recommended to improve bladder function in patients with nerve damage that affects bladder control.

Overall, bladder surgery is typically recommended for patients who have severe and persistent bladder problems that significantly impact their quality of life and cannot be managed with other treatments.

Timeline

Before bladder surgery, a patient may experience symptoms such as frequent urinary tract infections, urinary incontinence, bladder pain, or difficulty emptying the bladder. They may undergo various tests and evaluations to determine the best course of treatment, which may include medication, physical therapy, or other non-invasive treatments.

After bladder surgery, the patient will likely need to stay in the hospital for a few days to recover. They may experience pain, discomfort, and urinary catheterization during this time. As they heal, they will gradually be able to resume normal activities and may need to follow a specific diet or take medication to prevent infection and promote healing.

Long-term, the patient may need to make lifestyle adjustments to accommodate their new bladder function. They may need to monitor their fluid intake, practice pelvic floor exercises, and attend follow-up appointments with their healthcare provider to ensure proper healing and function. Overall, bladder surgery can significantly improve a patient’s quality of life and alleviate symptoms associated with lower urinary tract problems.

What to Ask Your Doctor

  1. What are the benefits of vascularized bladder transplantation compared to using parts of the intestine for bladder surgery?
  2. What are the potential risks and complications associated with vascularized bladder transplantation?
  3. How long does the transplanted bladder typically last in patients who undergo this procedure?
  4. How does the use of a robot in the procedure impact the feasibility and accessibility of vascularized bladder transplantation?
  5. What are the criteria for patients to be eligible for combined kidney and bladder transplants?
  6. What is the success rate of vascularized bladder transplantation compared to traditional bladder surgery methods?
  7. How does suppressing the immune system to prevent rejection of the transplanted bladder impact the patient’s overall health and recovery?
  8. Are there any long-term effects or considerations that patients should be aware of after undergoing vascularized bladder transplantation?
  9. How does the cost of vascularized bladder transplantation compare to traditional bladder surgery methods?
  10. Are there any ongoing research or developments in the field of abdominal organ transplants that may impact the future of bladder surgery procedures?

Reference

Authors: Piovesan AC, Andraus W, Pellanda AB, David Neto E, D Albuquerque LC, Nahas WC. Journal: Arq Bras Cir Dig. 2024 Jun 17;37:e1808. doi: 10.1590/0102-6720202400015e1808. eCollection 2024. PMID: 38896703