Can I Live Without My Bladder?

Yes. You can live without a bladder. However, you still need something that can perform the two basic functions of the bladder: storing and emptying of urine. Physicians have come up with many ways over the years to accomplish these tasks, many of which are still used today. The simplest alternative is to place drainage tubes into the kidneys that come out through the skin and connect to bags on the abdomen. These tubes are known as nephrostomy tubes.

Nephrostomy tubes are typically inserted into a person in the X-ray department by an  interventional radiologist who uses some light sedation. For the patient, the bag provides an easy way to store urine and can be drained several times a day when convenient by opening a small valve on the bag. These tubes can be uncomfortable, however, and may also be easily removed if tugged; therefore, they are only reasonable solutions for a short period of time or for patients who are too ill to undergo surgery. It is also possible to surgically bring the ureters directly to the skin surface (called a cutaneous ureterostomy).

The urine then can be collected with a bag attached to the skin around the opening. Unfortunately, the ureters are relatively small, and thus any scarring or narrowing of the opening can cause a blockage of urine. This tendency to get blocked also makes cutaneous ureterostomies a poor long-term solution. To provide a good long-term solution, surgeons most commonly use a portion of the small bowel to act as the new bladder. The identified piece of small bowel is removed from the main portion and is fashioned for its new use (see Question  for details). The urine that collects within this piece of bowel will ultimately be drained in one of three ways.

First, the bowel can simply be left open at the skin for the urine to drain passively out into a bag that is attached to the abdomen. This type of drainage is known as a conduit, and the opening onto the skin is called a urostomy. Urine collects in the bag, which is then drained into a toilet several times each day. Second, the bowel can be sewn into a rough sphere connected to the skin by only a small, long channel. This channel prevents urine from leaking out but easily accommodates a small  catheter.

This is called a  continent urinary diversion. With this type of diversion, you must pass a catheter into the new bladder several times a day to drain the urine. This allows you to live without an ostomy bag, but for some patients, passing the catheter several times a day may be difficult or impossible. Third, the new bladder can be directly reattached to the urethra (called an  orthotopic neobladder).

This allows you to urinate almost normally, although you do need to learn to use different muscles, as the new bladder replacement is not able to contract on its own. This is an excellent option for some people, but it is a longer, more difficult operation with some  risk of  incontinence. For more details on these procedures and more discussion about which option may be right for you, see Question .