The method of orthotopic intestinal plastics of the bladder. Intestinal plasty of the bladder Intestinal plasty of the bladder

The bladder performs the function of collecting, storing and pushing urine out. It is located in the small pelvis, consists of the top, body, bottom, neck, which smoothly passes into the urethra. The bladder sphincter controls the retention of urine and is located at the junction of the urethra and the bladder wall. In various diseases, the process of accumulation or excretion of urine is disrupted, and in advanced cases, treatment can only be surgical. The most common groups of operations are plastic and reconstructive.

What is bladder plastic surgery?

Under the plastic of the bladder understand a number of operations used to restore its reservoir function. Most often they are prescribed for complete or partial removal of the organ, mainly for cancer. To form a new section of the bladder, a part of the small or large intestine is used, providing the necessary circulatory system. During the rehabilitation period and beyond, a person will need regular monitoring of the frequency of going to the toilet, because after a complete modeling of the organ, he experiences urges.

Indications for intervention

In newborns, the main indication for plastic surgery is a very serious congenital disease, in which the bladder is located outside the body. It does not have an anterior wall, the corresponding section of the peritoneum is also missing. Urine flows out through the openings of the ureters, the urethra is absent or split (urethral epispadias). With exstrophy, plastic surgery is performed already on the 5th day of a newborn's life.

In addition, the operation is necessary when the organ ceases to perform its functions and it is impossible to restore its work in a conservative way. Usually this happens with a tumor process (bladder cancer) that affects the walls, neck, bottom. If the tumor is small, the organ is not completely removed. Otherwise, removal of the entire bladder without residue is indicated.

Other possible indications for plastic surgery:

cancers of the prostate with metastases to the bladder;
deformation of the organ due to severe adhesions;
congenital anomalies in the structure of the organ, except for exstrophy;
large stones in the organ that caused damage to it;
severe bladder injury;
, abscesses.

Contraindications

The operation may be contraindicated in the general serious condition of the patient, when there is a threat of complications during anesthesia. In this case, lighter emergency interventions are made with a palliative purpose, after the normalization of health, plastic surgery is performed as the second stage. You will also have to wait with the operation for acute pyelonephritis, acute cystitis until the condition stabilizes. Interventions are contraindicated in inoperable tumor process with widespread metastases.

Preparing for the operation

An examination is required for the selection of drugs, the dosage of intravenous anesthesia, as well as clarifying the nature of the disease of the bladder.

Here is an approximate list of studies that the patient undergoes:

pelvis and kidneys (additionally for men -);
with a biopsy (if we are talking about a tumor);
CT scan of the bladder with contrast;
intravenous;
CT or MRI of the abdomen.

These examinations are not performed for each patient in the specified volume - the list is selected individually depending on the type of problem.

As before other operations, the patient undergoes standard examinations:

complete blood count, biochemistry;
general urine analysis;
blood for hepatitis, HIV, syphilis;
coagulogram;
fluorography.

In doubtful cases, screening tests for oncological diseases are prescribed. If inflammation is suspected, a urine culture is additionally performed. As a preparation, 2-3 days before the operation, you should switch to a light meal, 6 hours before the plastic surgery, do not eat or drink, stop smoking immediately before it, and do an enema.

If a part of the intestine is to be taken to create a hollow organ, the following preparation is additionally performed:

limiting fiber intake;
regular enemas;
taking sorbents and intestinal antiseptics.

Execution technique

There are several types of bladder surgeries. In any case, their goal is to restore the ability to divert urine by forming an artificial organ. The specific method is selected according to indications. Age characteristics and general health are also taken into account.

Intestinal technique

Sigmoplasty is a type of bladder plastic surgery that involves using part of the large intestine to recreate a removed organ. The structural features of the sigmoid colon are such that it can be used to form the bladder.

The operation technique is as follows:

introduction of general anesthesia;
opening of the abdominal cavity;
excision of a part of the intestine about 12 cm long;
processing of the intestine, the connection of its parts;
transplantation of ureters into an intestinal graft;
suturing of the organ, suturing incisions.

Technique for performing intestinal plasty of the bladder

Orthotopic

The most common operation after a total or partial cystectomy (removal of the bladder) is plastic surgery involving a segment of the ileum. They are recognized as the gold standard for cancer and other bladder pathologies. During the operation, a low-pressure urinary reservoir is made. This type of plastic is called orthotopic.

The course of the operation is as follows:

enter endotracheal anesthesia;
remove the bladder and regional lymph nodes through a median laparotomy, if possible, preserve the neurovascular bundles and ligaments of the urethra;
make the mobilization of the terminal ileum, pre-delimit the peritoneum due to the risk of ingestion of intestinal contents;
put interintestinal anastomosis between the distal and proximal ends of the intestine;
a rectangle is obtained from the intestine, its edges are combined in a special way and an artificial U-shaped bladder is formed;
the reservoir is sutured to the ureters;
the urethra is moved so that it is aligned with the reservoir, the organs are fixed with sutures, and the stents are removed.

Neck plastic

Typically, this type of operation is performed when this part of the bladder is affected, as well as as part of complex surgery for exstrophy of the organ. The bladder is opened along the median line, the flap is excised in the cervical region. From part of the intestine or by reducing the bladder form a new neck and urethra (if necessary). With exstrophy, the peritoneal defect is eliminated, the pubic bones are brought together, which improves the retention of the sphincter and neck.

Technique for bladder neck plastic surgery

rehabilitation period

In the first days after the operation, the patient should not eat in the usual way if the intestines were involved in the operation. Nutrition during this difficult period is only intravenous. Within 14 days, urine is collected through an opening on the anterior abdominal wall, to which an external reservoir is supplied. This is necessary for the full healing of the new organ and its junction with the urethra, ureters. After 3-5 days, they begin to wash the artificial bladder with saline.

After 2 weeks, catheters and drainage tubes are removed, sutures are removed. Urination becomes natural. It is best to perform the act of urination while sitting (even for men). A person must learn to empty the bladder with the pressure of the abdominal muscles, so he has to push and press his hand a little on the stomach. There is no urge to empty the organ, this must be strictly monitored, otherwise inflammatory processes will occur inside the body. As a complication of untimely urine diversion, a rupture of a new organ may occur.

The frequency of emptying the bladder - every 3-4 hours, including at night. So you have to live in the first 3 months. Further, the organ will stretch, and the intervals will lengthen to 4-6 hours. At night, you still need to get up at least 1 time, which you need to get used to.

drink diuretics more often, lingonberry infusion - it removes the mucus secreted by the intestines (otherwise the mucus can clog the urethra);
take a lot of water;
within 2 months do not drive a car, do not lift weights;
do not eat fried, spicy foods that slow down the healing of stitches;
start doing exercise therapy a month after the operation (gymnastics is needed to strengthen the muscles of the pelvic floor).

Bladder plastic. This term refers to plastic surgery performed with various anomalies of its development. For example, partial or complete replacement of an organ with a segment of the large or small intestine.

Bladder plastic surgery

How is bladder plastic surgery performed?

Particularly often, plastic surgery is performed with exstrophy of the bladder - a very serious disease that combines a number of defects in the bladder, urethra, abdominal wall and genital organs. The anterior wall of the bladder and the corresponding part of the abdominal cavity are practically absent, which is why the bladder is actually outside.

Plastic surgery for exstrophy is carried out as early as possible - 3-5 days after the birth of the child. Depending on the case, it includes a number of operations, such as:

primary plasty - elimination of a defect in the anterior wall of the bladder, its placement inside the pelvis and modeling;
elimination of abdominal wall defect;
reduction of the pubic bones, which improves urinary retention;
the formation of the neck of the bladder and sphincter to achieve control over urination;
ureteral transplant to prevent reflux of urine into the kidneys.

Fortunately, such a disease as exstrophy of the bladder is quite rare.

Bladder plastic surgery for cancer

How is an artificial bladder created with the help of plastic surgery?

Another case of bladder plastic surgery is reconstruction after cystectomy (removal of the bladder). The main reason for this operation is cancer. When removing the bladder and adjacent tissues, through plastic surgery, they achieve different ways of diverting urine. We list some of them:

From a small section of the small intestine, a tube is formed that connects the ureter to the surface of the skin of the abdominal wall. A special urinal is attached near the hole.

From various parts of the gastrointestinal tract (small and large intestines, stomach, rectum) a reservoir is formed for the accumulation of urine, connected to an opening in the anterior abdominal wall. The patient empties the reservoir on his own, i.e. he has the ability to control urination (autocatheterization)

Creation of an artificial bladder in plastic surgery. A section of the small intestine is connected to the ureters and urethra, which is possible only if they have not been damaged and removed. The method allows you to make the act of urination as natural as possible.

Thus, plastic surgery performed on the bladder plays an important role in improving the quality of life of the patient. Its goal is to facilitate and take control of the process of urination as much as possible, thereby giving the patient the opportunity to live a full life.

The invention relates to medicine, urology, and can be used for plastic surgery of the bladder after its removal. A U-shaped intestinal reservoir is formed from the ileum graft. The graft is dissected along the antimesenteric edge. In the resulting rectangle, the long shoulder is bent in the middle. The edges are combined and sutured from the mucosal side with a continuous suture. Match opposite long sides. Get a U-shaped tank. The edges of the Komi graft are compared and sutured for 4-5 cm. The ureters are anastomosed with a formed reservoir. Form the urethral tube. At the same time, the lower lip of the graft is moved towards the urethra. Connect the upper lip and two points of the lower lip with a triangular seam. A urethral tube is formed from the formed flap. A Foley catheter is passed into the graft through the urethra. The ureteral stents are withdrawn in the opposite direction. Anastomose the urethral tube with the urethra. The edges of the graft are matched with adaptive sutures. The method allows to prevent the failure of the anastomosis between the reservoir and the urethra. 12 ill., 1 tab.

The invention relates to the field of medicine, urology, specifically to methods of orthotopic intestinal plastics of the bladder and can be used after bladder removal operations.

Known methods of orthotopic plastics, aimed at diverting urine into the intestine, date back to the middle of the 19th century. Simon in 1852 diverted urine from a patient with exstrophy of the bladder by moving the ureters into the rectum, thus achieving retention of urine using the anal sphincter. Until 1950, this urinary diversion technique was considered the leading one for patients who required urinary diversion with retention. In 1886, Bardenheüer developed the methodology and technique for partial and total cystectomy. A known method is ureteroileocutaneostomy (Bricker) - diversion of urine on the skin through a mobilized fragment of the ileum. For a long time, this operation was the gold standard for urinary diversion after radical bladder surgery, but the solution to this problem is far from being resolved to date. The method of removing the bladder must end with the formation of a well-functioning urinary reservoir. Otherwise, a number of complications associated with urinary incontinence develop, leading to a deterioration in the quality of life of the patient.

The closest to the proposed method in terms of technical implementation is the method of forming a U-shaped low-pressure reservoir from a fragment of the ileum, performed after radical cystectomy, including radical cystectomy, the formation of a U-shaped reservoir from 60 cm of the terminal ileum after detubularization and reconfiguration of the intestinal graft , forming a hole at the lowest point of the graft to form an anastomosis between the urethral stump and the formed intestinal graft. However, in case of destruction due to a severe pathological condition of the anatomical formations responsible for urinary retention, complications are observed during the formation of the reservoir using this method, consisting in urinary incontinence. Since one of the difficult stages of the operation, taking into account the anatomical features of the location of the urethra, is the formation of an anastomosis between the reservoir and the urethra, the failure of the anastomosis leads to leakage of urine in the early postoperative period and the development of a stricture of the enterocystourethral anastomosis in the late postoperative period, Table 1.

A new technical task is to prevent intraoperative and postoperative complications and improve the quality of life of patients after operations associated with the removal of the bladder.

The problem is solved by a new method of orthotopic intestinal plastics of the bladder, which consists in the formation of a U-shaped intestinal reservoir of low pressure from the transplant of the terminal ileum and the channel for urine diversion, and the channel is a urethral tube 5 cm long, which is formed from the distal lip of the intestinal reservoir , for which the lower lip of the graft is moved towards the urethra and connected to the upper lip at two points of its lower lip with an angled suture, forming a flap, when the edges of the graft are sewn together with a single-row serous-muscular suture, the urethral tube is formed, after which the mucosa of its distal end is turned outward and fixed with separate sutures to the serous membrane of the transplant, after which a three-way Foley catheter is passed through the urethra and the formed urethral tube, and external ureteral stents are removed from the intestinal reservoir in the opposite direction, then anastomosis is performed with 4-6 ligatures for 2, 4, 6, 8, 1 0, 12 hours, after that, the edges of the right and left knees of the graft are compared with interrupted adapting L-shaped sutures, after which the anterior wall of the intestinal reservoir is fixed to the stumps of the pubic-vesical, pubo-prostatic ligaments or to the periosteum of the pubic ligaments with separate sutures from a non-absorbable thread.

The method is carried out in the following way.

The operation is performed under endotracheal anesthesia. Median laparotomy, perform a typical radical cystectomy and lymphadenectomy. If the conditions of the radical nature of the operation allow, the neurovascular bundles, the ligamentous apparatus of the urethra, and the external striated sphincter are preserved. Perform mobilization of 60 cm of the terminal ileum, retreating 20-25 cm from the ileocecal angle (Figure 1). With a sufficient length of the mesentery, as a rule, it is enough to cross the artery of the arcade vessels closest to the wall of the intestine, but at the same time they try to keep straight vessels, while dissecting the mesentery to a length of 10 cm, which is sufficient for further actions. The free abdominal cavity is delimited from the possible ingress of intestinal contents with 4 gauze napkins. The intestinal wall is crossed at a right angle with preliminary ligation of the vessels of the submucosal layer. The patency of the gastrointestinal tract is restored by applying an interintestinal anastomosis between the proximal and distal ends of the intestine - "end-to-end" with a two-row interrupted suture, so that the formed anastomosis is above the mesentery of the mobilized intestinal graft. The proximal end of the graft is clamped with a soft clamp and a silicone probe is inserted into the intestinal lumen, through which a warm 3% solution of boric acid is injected to remove the intestinal contents. After that, the proximal end of the graft is released from the clamp and straightened evenly on the probe. Scissors dissect the intestinal graft strictly along the antimesenteric edge. From the fragment of the intestine, a rectangle is obtained, having two short and two long arms. On one of the long arms, a point is isolated strictly in the middle, around which the long arm is bent, the edges are combined, and from the mucosal side, a continuous through, twisting (according to Reverden) suture is sutured (Figure 2). Further, opposite long sides are combined so that a U-shaped tubular reservoir is obtained. This stage is the main one in this method and it consists of a number of actions. The first action consists in matching and suturing for 4-5 cm the edges of the right and left knees of the resulting graft (Figure 3). The second step is to anastomose the ureters with the intestinal reservoir with antireflux protection on ureteral external stents (Figure 4). The third step is to form the urethral tube by moving towards the urethra of the lower lip of the graft, connecting the upper lip and two points of the lower lip of the graft with a fillet suture, so that a flap is formed (Fig. 5; 6), by suturing the edges of which with a single-row interrupted suture, a urethral tube 5 cm long is formed, the mucosa of the distal end of the tube is turned outward and fixed with separate sutures to the serous membrane of the graft (Fig.7). A three-way Foley catheter is inserted into the graft through the urethra and the formed urethral tube, and external ureteral stents are removed from the reservoir in the opposite direction. The fourth action is (in the imposition of an anastomosis) in the anastomosis of the urethral tube with the urethra, which is performed with 4-6 ligatures for 2; four; 6; eight; 10 and 12 o'clock of the conventional dial. The fifth action is to match the edges of the right and left knees of the intestinal graft to a triangular suture, given that the lower lip is shorter than the upper lip, the comparison is made with interrupted adaptive L-shaped sutures (Fig.8). The sixth action - to prevent possible displacement of the graft and deformation of the urethral tube with separate sutures from a non-absorbable thread, the anterior wall of the reservoir is fixed to the stumps of the pubovesical, puboprostatic ligaments or to the periosteum of the pubic bones. The dimensions and shape of the graft in general terms are shown in Fig.9.

Justification of the method.

The main criteria for the surgical technique of radical cystectomy, under which the likelihood of urinary incontinence after the formation of the intestinal reservoir is minimal, is the maximum possible preservation of the anatomical formations of the urethra and neurovascular complexes. However, in a number of cases: with locally advanced forms of tumor lesions of the bladder, after previous surgical interventions on the pelvic organs, after radiation therapy of the small pelvis, the preservation of these formations becomes an impossible task, and therefore the likelihood of urinary incontinence increases significantly. In addition, one of the difficult stages of the operation, given the anatomical features of the location of the urethra, is the formation of an anastomosis between the reservoir and the urethra. The failure of the anastomosis leads to leakage of urine in the early and development of stricture enterocystourethral anastomosis in the late postoperative period. The reduction of these complications is possible in the case of favorable conditions for the formation of the anastomosis, which are created during the formation of the urethral tube. The formed reservoir does not interfere with the conduction and tightening of ligatures from the formed tube. The formation of the urethral tube from the graft wall allows you to maintain adequate blood circulation in the wall of the urethral tube, and to prevent possible displacement of the graft and deformation of the urethral tube, it is fixed with separate sutures from a non-absorbable thread to the anterior wall of the reservoir to the stumps of the pubovesical, puboprostatic ligaments or to the periosteum pubic bones. The result is a triple urinary continence mechanism.

Example: Patient A. 43 years old. He turned to the urological department in the order of planned care with a diagnosis of bladder cancer, a condition after combined treatment. In anamnesis, the patient was diagnosed 6 years ago at the time of admission. During the follow-up, the following operations were performed: bladder resection and two times TUR of a bladder tumor. Two courses of systemic and intravesical chemotherapy, one course of external beam radiation therapy. At the time of admission clinically shriveled (effective bladder volume not more than 50 ml), severe pain syndrome, frequency of urination up to 25 times a day. The diagnosis was confirmed histologically. Conducted instrumental methods of examination: ultrasound of the abdominal organs, CT of the pelvic organs, isotope bone scintigraphy, X-ray of the chest organs - data for distant metastases were not received. Given the recurrence of the disease, the changes that developed in the bladder, which significantly worsened the patient's quality of life, it was decided to perform a radical operation. However, given the nature of the developed complications, it was decided to perform a two-stage treatment option. The first step is to perform a radical cystectomy with ureterocutaneostomy, and the second step is an orthotopic intestinal plasty of the bladder. The first stage of the operation was performed without serious complications; after a three-month rehabilitation, the patient underwent orthotopic plastic surgery of the bladder. Taking into account the fact that during the first stage of the operation there was no possibility of preserving the neurovascular bundles and the external striated sphincter and ligamentous apparatus of the urethra, the variant of plastic surgery was chosen as the option of forming an intestinal reservoir with an additional mechanism for urinary retention - a U-shaped reservoir of low pressure with the formation of a urethral tubes. The operation was performed without technical difficulties, without complications in the early postoperative period. The ureteral catheters were removed on the 10th day, and the urethral catheter - on the 21st day. Up to 3 months after the operation, nighttime urinary incontinence persisted (despite the fact that the patient strictly followed all the recommendations). Subsequently, adequate urination was restored. The patient returned to his previous work. When the milestone examination after 12 months noted the achievement of the capacity of the intestinal reservoir up to 400 ml at a maximum urine flow rate of 20 ml/s (Fig.10). When conducting retrograde urethrography, a typical structure of the urinary reservoir is noted (Fig.11; 12).

This method of treatment was used in 5 patients, all men. The mean age was 55.6 years (range 48 to 66). Three patients were operated on in a multi-stage manner, and two patients were operated on in one stage. The duration of observation reaches 18 months. All patients have urinary retention day and night. One patient, 66 years old, could not empty the reservoir completely up to 4 months after the operation, which required regular catheterization of the urinary reservoir, and subsequently independent adequate urination was restored. One 53-year-old patient developed a stricture of the vesicourethral anastomosis 6 months after the operation. This complication was eliminated by optical urethrotomy. The most common complication is erectile dysfunction observed in 4 patients.

Thus, the proposed method can be successfully used in a contingent of patients suffering from lesions of the bladder, requiring radical surgery, during which it is not possible to preserve the anatomical structures responsible for urinary retention, shown are options for orthotopic bladder plastics with additional urinary retention mechanisms, one of which is is the formation of the urethral tube according to the proposed method.

Table 1
List of complications after the formation of urinary reservoirs from various parts of the gastrointestinal tract (excluding cardiovascular and pulmonary complications)
	R	P
1	Urine leakage	2-14%
2	Urinary incontinence		0-14%
3	Intestinal failure	0-3%
4	Sepsis	0-3%	0-3%
5	Acute pyelonephritis	3%	18%
6	wound infection	7%	2%
7	Wound eventration	3-7%
8	Gastrointestinal bleeding	2%
9	Abscess	2%
10	Intestinal obstruction	6%
11	Bleeding of the intestinal reservoir	2%	10%
12	Intestinal obstruction	3%	5%
13	ureteral obstruction	2%	6%
14	Parastomal hernia		2%
15	Stenosis of the entero-ureteral anastomosis	6%	6-17%
16	Stenosis of the entero-urethral anastomosis		2-6%
17	Stone formation		7%
18	Reservoir overstretch		9%
19	metabolic acidosis		13%
20	reservoir necrosis		2%
21	Volvulus		7%
22	reservoir stenosis		3%
23	Entero-reservoir fistula		<1%
24	External intestinal fistula	2%	2%

Literature

1. Matveev B.P., Figurin K.M., Koryakin O.B. Bladder cancer. Moscow. "Verdana", 2001.

2. Kucera J. Blasenersatz - operationen. Urologische operationslehre. Lieferung 2. 1969; 65-112.

3. Julio M. Pow-Sang, MD, Evangelos Spyropoulos, MD, PhD, Mohammed Helal, MD, and Jorge Lockhart, MD Bladder Replacement and Urinary Diversion After Radical Cystectomy Cancer Control Journal, Vol.3, No.6.

4. Matveev B.P., Figurin K.M., Koryakin O.B. Bladder cancer. Moscow. "Verdana", 2001.

5. Hinman F. Operative urology. M. "GEOTAR-MED", 2001 (prototype).

A method for orthotopic intestinal plasty of the bladder, including the formation of a U-shaped intestinal low-pressure reservoir from a graft of the terminal ileum and a urine diversion canal, characterized in that to form a reservoir, the intestinal graft is cut along the antimesenteric edge, obtaining a rectangle having two short and two long arms, on one of the long arms, a point is selected in the middle, around which the long arm is bent, the edges are combined and from the mucosal side are sutured with a continuous through, twisting seam, then the opposite long sides are combined so that a U-shaped tubular reservoir is obtained, matched and sutured for 4-5 cm the edges of the graft knees, anastomose the ureters with a formed reservoir with antireflux protection on the ureteral external stents, then form the urethral tube, for which the lower lip of the graft is moved towards the urethra, the upper lip and two points of the lower r are connected graft with a triangular suture so that a flap is formed, by suturing the edges of which a urethral tube 5 cm long is formed with a single-row interrupted suture, then the mucosa of the distal end of the tube is turned outward and fixed with separate sutures to the serous membrane of the graft, a three-way Foley catheter, external ureteral stents are removed in the opposite direction, the urethral tube is anastomosed with the urethra with 6 ligatures for 2; four; 6; eight; 10 and 12 o'clock of the conventional dial, the edges of the graft are compared to the triangular suture, given that the lower lip is shorter than the upper lip, the comparison is made with interrupted adaptive L-shaped sutures and then the anterior wall of the intestinal reservoir is fixed to the stumps of the pubovesical, puboprostatic ligaments or to periosteum of the pubic bones.

Bladder plastic surgery is a forced surgical intervention, during which either the whole organ or part of it is completely replaced.

Such an operation is performed only for special indications, when anomalies of the bladder do not allow the organ to perform all the necessary functions.

The bladder is a muscular hollow organ whose functions are to collect, store and excrete urine through the urinary ducts.

The organs of the urinary system

It is located in the small pelvis. The configuration of the bladder is completely different, depending on the degree of its filling with urine, as well as on the adjacent internal organs.

It consists of the top, body, bottom and neck, which gradually narrows and smoothly passes into the urethra.

The upper part is covered with peritoneum, which forms a kind of notch: in males it is rectal-vesical, and in females it is vesico-uterine.

In the absence of urine in the body, the mucous membrane is collected in a kind of folds.

The sphincter of the bladder provides control of urinary retention, it is located at the junction of the bladder and the urethra.

The bladder in a healthy person allows you to collect from 200 to 400 ml of urinary fluid.

The temperature of the external environment and its humidity can affect the amount of urine excreted.

The excretion of accumulated urine occurs when the bladder contracts.

However, when pathologies occur, the mechanism for performing the basic functions of the bladder is seriously impaired. This forces doctors to decide on plastic surgery.

The reasons

The need for plastic surgery of the bladder arises in cases where the organ has ceased to perform the functions intended for it by nature, and medicine is powerless to restore them.

Most often, such anomalies affect the mucous membrane of the bladder, its walls, as well as the neck of the urethra.

There are several diseases that can cause such pathologies, among which the most common are bladder cancer and exstrophy.

The main cause of cancerous organ damage is bad habits, as well as some chemical compounds.

Pathology of the bladder

The detected tumors, which are small in size, allow sparing operations to truncate them.

Unfortunately, large tumors do not allow you to leave the bladder, doctors have to decide on its complete removal.

Accordingly, after such a procedure, it is important to perform a replacement bladder plastic surgery, which makes it possible to ensure the functioning of the urinary system in the future.

Exstrophy is detected in the newborn immediately.

Such a pathology is not subject to treatment at all, the only possibility for the baby is to undergo a surgical intervention involving plastic surgery, during which the surgeon forms an artificial bladder capable of performing its intended functions without obstacles.

Technique

Exstrophy, which is a serious pathology that simultaneously combines anomalies in the development of the bladder, urethra, abdominal wall and genital organs, is subject to immediate plastic surgery.

Newborn treatment

This is also explained by the fact that most of the urinary organ has not formed, is missing.

A newborn undergoes bladder plastic surgery approximately 3-5 days after birth, because a child simply cannot live with such an anomaly.

Such a surgical intervention involves a phased plastic surgery. Initially, the bladder is placed inside the pelvis, then it is modeled, eliminating anomalies of the anterior and abdominal walls.

To ensure further normal retention of urine, the pubic bones are surgically reduced. They form the neck of the bladder and the sphincter, thanks to which it is possible to directly control the process of urination.

In conclusion, a ureteral transplant is mandatory to prevent reflux, when urine is thrown back into the kidneys. The operation is quite complicated, the only consolation is that the pathology belongs to the category of rare ones.

Bladder plastic surgery

Plastic surgery is also necessary in the case when the patient underwent a cystectomy upon detection of a cancerous disease. After complete removal of the bladder, a replacement organ can be created from part of the small intestine.

An artificial reservoir for collecting urine can be formed not only from the intestine, but in a complex from the stomach, rectum, small and large intestines.

As a result of such plastics, the patient has the opportunity to control urination independently.

Also, plastic surgery allows to ensure the most natural process of urination, during which a section of the small intestine is brought to the ureter and urethra, successfully connecting them.

Postoperative recovery

For several days, the patient is forbidden to eat to ensure a good flushing (disinfection) of all urinary organs.

Postoperative recovery

To maintain physical strength, intravenous nutrition is carried out. The postoperative period after plastic surgery lasts about two weeks, after which the drains, installed catheters are removed, and the sutures are removed.

It is from this moment that it is allowed to return to natural nutrition and physiological urination.

Unfortunately, the urination process itself is somewhat different from the physiological one. In a healthy bladder, the output of urine to the outside is carried out by muscle contractions of the bladder.

After plastic surgery, the patient will have to push and press on the abdominal part of the abdomen, under the influence of which urine will be released, and the artificial reservoir will be emptied.

To prevent infection of the urinary system, it is important to empty every three hours immediately after plastic surgery, and after six months - every 4-6 hours.

There are no natural urges, therefore, if such requirements are not observed, excessive accumulation of urine can occur, leading in many cases to rupture.

Urine after plastic surgery becomes cloudy because the intestines from which the reservoir was created continue to secrete mucus.

The blockage of the urinary ducts with this mucus can become a danger, so the patient is recommended to take lingonberry juice twice a day. Another important recommendation is to drink plenty of water.