I am routinely asked about the possibility of transplanting a new bladder. It is an interesting thought isn’t it. I mean, if you have a liver or kidneys that do not work right, then you are put on a list and hopefully will eventually receive one of these organs. Transplanting a bladder would be a wonderful option for those patients who bladders have failed them. Unfortunately, transplanting a bladder would be extremely risky and because having a working bladder is not mandatory to live, the risk is not worthwhile. That being said, having a malfunctioning bladder is no fun, and threatens a person’s quality of life.
That doesn’t mean that you are out of options if your bladder stops working. Previously I have spent a lot of time talking about incontinence. When I talk about a bladder not working, I am really specifically talking about the functions of the bladder, the ability to store urine at low pressures and the ability to eliminate urine at a low enough pressure to not transmit pressure to the kidneys. When the bladder is unable to store urine appropriately, you often end up with incontinence. There are many options to help the bladder store urine. I am going to use this share post to discuss some surgical options.
For a very long time the mainstay of improving bladder capacity and the ability to store urine was to augment the bladder. There are many different techniques for this, using various portions of bowel, and even stomach. Basically, we “borrow” a segment of bowel, leaving it attached to its blood supply and attach it to the bladder. This is often enough to keep a patient dry and be able to delay having to void. Unfortunately, this option usually leaves a patient with the inability to empty their bladder on their own, and most patients will have to catheterize themselves. This is the trade off. We also augment bladder when the pressures in the bladder are dangerously high and pose a threat to the kidneys.
For the most part, we reserve bladder augmentation for extreme cases these days. We now have other options that are less risky. I have discussed Botox in the bladder previously and this is a situation where it would really work. Neuromodulation is another option that I will discuss in another share post to come, but basically, it is a low level electrical stimulation that improves refractory urgency, frequency and incontinence due to uninhibited bladder contractions.
On the horizon is a very exciting possibility and it is the closest thing to a new bladder. At Wake Forest University they have been working on growing a bladder in a lab and implanting that into a person. It seems that a person’s cells will be cultured and grown in a lab. Eventually the new tissue will be implanted into the bladder and eventually be completely incorporated into the native bladder. This will hopefully improve capacity, compliance and still preserve the ability to eliminate urine voluntarily. The research is moving along nicely and hopefully will be a realistic option for humans in the near future.