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Urology

Bladder Replacement Surgery

The Section of Urology at Virginia Mason in Seattle has been a leader in bladder replacement surgery in the Northwest since 1988. To be considered for bladder replacement surgery, a patient needs to have his or her bladder removed as treatment for bladder cancer. Also, patients with neurogenic bladders or congenital anomalies requiring them to have a urine bypass from the bladder may be a candidate for this surgery. Many existing patients with a standard ileal conduit urinary diversion can also be successfully treated with a continent bladder replacement.

Initially, bladder replacement surgery done at Virginia Mason focused on the continent ileal reservoir, which is called the Kock pouch. This pouch required construction of two one-way valves, one to prevent urine from washing backward toward the kidneys, and one to prevent the urine from leaking out of the small, dime-sized opening, or stoma, at the abdominal wall. With this, patients catheterized four or five times per day to empty their pouches, and the rest of the time they wore small pads over the stoma. Unfortunately, the Kock pouch procedure to the skin does not hold up well over a long time period. Fortunately, most patients who need their bladders replaced can now have them replaced and connected back to the urethra so that they can urinate normally and not have a stoma on their abdominal wall.

Today, Virginia Mason performs the ileo-bladder replacement procedure, which some people term the "Kock pouch diversion to the urethra". This procedure offers the advantage of nearly perfect daytime urinary continence and rare problems with nighttime urinary control. Most patients — both men and women — can urinate without the need for catheterizing to empty their bladders.

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