Bladder transplant - dumb question?

[Daniel]

Hi all.

I am guessing that there is no such thing as a bladder transplant surgury. It seems like if there was, no one would be thinking about cystectomy.

Why is it that we can replace a kidney or even a heart...and recently even whole limbs from deceased donors, but we cannot replace bladders?

-Daniel

[jen_dahling]

Not quite sure this is correct, but I saw a health channel show about growing organs and such. The bladder can't be transplanted due to the high rate of infection and bladder stones. I think there was mention of stomach and other tissues used for the repair of some bladders, but it was awhile since I saw the show.

[Jeanne D.]

Bladders can be repaired or enlarged using part of the large intestine -- usually the cecum. They cannot be transplanted due to their nerve supply. The pelvic nerves carry the impulses generated by a filling bladder to the sacral spinal cord, these sensations are then carried to the cerbral cortex (both are part of the Central Nervous System), which makes us conscious of the urge to urinate. If these nerves are severed or damaged, voluntary urination cannot take place.

Jeanne

[Judith56]

If I remember correctly they have been working on a bladder transplant and they tried doing one a couple of years ago, maybe last summer. I am assuming it was no great success as I think we have heard all about it in the news. When I had my augmentation done years ago they used my ileal cecal segment to make it bigger. My internal pouch is made from my transverse colon. Judith

[Dixiefireball]

My doctor told me this.
at one time they was taking pig bladder and replaceing our ic bladder with pig bladders this seem to be fine for a while and they did ten or so more pat. until about a year later the women was coming back and having some type of more problems then they did with ic. Not sure what type of problems but it was major.
i was told this after i was dx because if i could get another bladder i wanted one.
I don't know how much of this story is true of even if i got it right but i do know for a fact it was a pig's bladder and there was alot of problems with it.

[Jeanne D.]

Rhonda,

You are correct. Many years ago they did try to transplant pig bladders into IC and bladder cancer patients. The transplanted bladders had to be catheterized -- no voluntary voiding due to the interrupted nerve supply, and many of the new bladders that were transplanted into IC patients developed IC! There were also problems with rejection and infection. It was better for the patient to have a cystectomy with a urinary diversion, if surgery was required. At least they did not have to take anti-rejection drugs. I learned of this when I worked in the operating room. I became certified in urology by the AUAA and was in charge of all of the urological surgeries. I worked in a teaching hospital and I learned a lot from the urology residents and attendings.

Jeanne

[Daniel]

I asked my urologist this question today. He had no idea about it.

Odd.

[mayray518]

I think some day in the far future they will be able to transplant bladders. I read somewhere about experimentation with it in Europe. However, when I brought it up to my urologist a few years ago he told me they couldnt do it because of nerve endings, etc. It isnt an organ that can be replaced like a liver, heart, etc. And dont you get sick of people saying "Just get a transplant." I dont know how many times I heard that.

[janetm]

Jeanne,

Thanks for the great information. It's nice to have someone with a medical background sharing what they know here.

Janet

[mayray518]

Interesting Jeanne, then it would seem as if the urine causes the problem if a new bladder gets IC.

[Jeanne D.]

No one really knows why this happens. An augmented bladder that has been enlarged or repaired with cecum can also get IC or EC. Cecum is bowel tissue, and once it becomes part of the bladder it can be affected.

[Judith56]

When I had my bladder augmented, they left the bladder base, also known as the trigone. They used the ileal cecal segment to enlarge my bladder or essentially rebuild it. Because the a part of my bladder was still there the IC then sprread to the newly augmented bladder. Eight months after my augmentation I had everything removed, including my urethra and was given an ileal conduit. Also after my augmentation I went into permanent retention so the only way I could urinate was to catheterize myself.I also started to form bladder stones with my augmented bladder. So I was very happy to part with it :). Of course what happened to me may not be someone else's experience. Judith

[Pain]

Interesting about the nerve endings and how that all works. Since I woke up with this pain 4 1/2 years ago, I have never had a normal "urge to go" feeling...EVER. I just have pain pain pain and more pain. I never have "I need to go" normal urge. I never have the "relief" of "oh I just went". The only nerve messages that my brain receives from my bladder are severe pain signals. So my "urge nerve signals" are already destroyed. Either that or the urine is getting through the lining (which is gone) and deep into the wall where the nerve fibers all are...which are many from what I understand...thousands of tiny nerve fibers. Hence why a simple nerve injection or God forbid nerve cutting operation (NEVER) won't work for IC. Too MANY nerves involved..a very complex system indeed. I am unique in that I have 24/7 severe constant pain AND my urine is literally FILLED with tissue almost all the time. Contrary to the "dumb" lab techs it is NOT "contamination from outside sources". That was proved through numerous PAINFUL cath samples..which no can do anymore...the urethra is too shot to even handle an infant catheter now.

I have BEGGED for them to "study" my urine though and was sad to see a few trials "die" that were to look at the cell slough off of IC patients even though I know not all have the quantity of visible tissue slough that I do. It's to the point I FEEL slivers come out when I urinate...almost like stones but they are not stones or stone like material - not that sharp...just "skin"....like sunburn skin peeling but I can feel them come out of my screwed up urethra and it's creepy. So is when I pee in a clear glass and have a look. I could build a sand castle with "the stuff".

We used to call him here the "white strings or stringys" here on the board a few years ago. I am unique in that I have had those since DAY ONE with the severe pain. So I can SEEEEEEEE my bladder disintegrating right before my eyes. And I sure the heck can FEEEEELLLLL it too.

[blue angel]

Judith, please tell me more about this. I have an appointment on 1 sept at the Mayo clinic in AZ, I'm comtemplating a bladder removal. How was it for you? Blue Angel

[Judith56]

Blue Angel, what would like to know? It has been 18 years since I had my bladder out and I am so thrilled, still, not to have to deal with IC anymore. Judith

[blue angel]

Judith I would like to know everything you can tell me about this type of surgery. Iam nerves about it because to this point I have heard many negatives. I would appreciate any information you can give me. Thanks

[Judith56]

Hi Blue Angel! Which surgery are you interested in? The augmentation, the bladder removal ( cystectomy) with an ileal conduit or an internal pouch?

[Carl]

My wife has a dead bladder.The news that we have is their is something that is in the works for transplant.But it wont be around till 2010.
At the moment ppl who hav a bladder problem. Have the value of botox and the bag. Which is quite a down fall,To the self confidance.




carl
:loco:

[Kara29]

Carl,

At the moment I have to agree with your feelings. Even though I know there are other options for your wife. I am in the process of going through major reconstruction myself due to a urethra that won't give me a life. My options are limited becuase I've already had bladder removal. I will take some time to point out some possibilities that a specialist in then uro/genital reconstructive pelvic surgery field could discuss with you. This is a devastating thing to have for you and your wife to suffer through. You may want to check out specialists that deal with people who have bladder cancer as my close Friend Amy pointed out to me when I could find no other urologists to deal with my situation. Urologists some of them, "some of them" tend to take the easy way out and say Botox or Bag and not think about the other possibiliites.

This site gives information on:

*What is urinary reconstruction and diversion?
*Urinary diversion options.
*Ileal Conduit Urinary Diversion (Advantages and Disadvantages)
*Indiana Pouch Reservoir (Advantages and Disadvantages)
*Neobladder to Urethra Diversion (Advantages and Disadvantages)
*A Look at the Three Surgical Procedures

*What can I expect in the immediate post-op period?
*What restrictions will I face regarding work, activities, diet, or travel?
*Urinary Tract Anatomy

You can find the full information on all of this including a printer friendly version if you want to take it to discuss with your doctor.

The link is here: http://www.clevelandclinic.org/health/health-info/docs/3900/3927.asp?index=12546&src=news

I just though this may be some helpful information to those of you whom are considering having thier bladders removed.

Kara