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Journalism of Courage
In a first, doctors at University of California, Los Angeles Health and Keck Medicine University of Southern California have performed a human bladder transplant, which can be a game changer for people suffering from bladder dysfunction because of long-time dialysis.
The surgery was conducted on May 4 by UCLA urologic transplant surgeon Dr Nima Nassiri and founding executive director of the USC Institute of Urology, who had been working for years to develop and refine the surgery technique. The surgery was performed on a 41-year-old patient who had previously lost most of his bladder during a tumour removal process, leaving the remainder too small and compromised to work. Both of his kidneys were also subsequently removed due to cancer and end-stage kidney disease, and he had been on dialysis for seven years.
The complex procedure involved the transplantation of both a new bladder and a new kidney, recovered from a donor. The doctors first transplanted the kidney, followed by the bladder; they then connected the kidney to the new bladder using the technique they had pioneered. The entire procedure lasted approximately eight hours. According to Dr Nassiri, the results were quickly evident. “The kidney immediately made a large volume of urine and the patient’s kidney function improved immediately. There was no need for any dialysis after surgery, and the urine drained properly into the new bladder.”
Why is this surgical technique significant?
According to Dr Nikhil Khattar, associate director, urology, PSRI Hospital, Delhi, the goal of the transplant was to restore urinary function using a donor organ. Unlike previous reconstructions using intestinal tissue, which has limitations, this approach involved replacing the bladder with a real human organ to improve quality of life and bodily function.
“There are often situations where the bladder gets severely damaged, particularly in conditions like tuberculosis, where it may shrink significantly after radiation therapy; or in cases of neurogenic bladder where the bladder loses its function. In such scenarios, we often need to reconstruct the bladder completely or at least enlarge it,” he says.
The biggest problem with intestinal tissue is that it has the natural tendency to absorb whatever comes in contact with it unlike the bladder which stores and expels urine without absorbing anything. “If the patient has already lost one kidney, this reabsorption of waste adds additional pressure on the remaining kidney, which could be dangerous especially in patients with already compromised kidney function. In such cases, bladder transplantation becomes a significant and promising step,” explains Dr Khattar.
Can a transplanted bladder fully replicate the function of a natural bladder?
In this kind of transplant, muscular function may be limited and vascular coordination is more crucial. “Connecting the appropriate nerves and vessels is essential,” says Dr Khattar.
How will it help patients in India?
Although kidney transplants are common now, transplant surgeons don’t take up cases of patients who have weak bladder and kidneys. That’s because a new kidney will not help if the bladder is compromised. In that sense, this offers hope.
