Rare neobladder surgery successfully done at United Hospital

Dr MA Zulkifl, senior consultant of the urology department of the United Hospital and his team successfully completed a rare radical cystoprostatectomy with orthotopic neobladder reconstruction surgery recently. 

The 60-year-old male patient was diagnosed with bladder cancer about one month ago and was also suffering from diabetes, high blood pressure and cardiac problems. 

He initially underwent endoscopic surgery named TURBT in another hospital to remove the bladder tumour. 

The patient was later referred to Dr MA Zulkifl when the tumour turned into high grade bladder cancer and spreaded inside the bladder muscle, said a media statement issued on Wednesday. 

To save the patient's life, a decision was made to do a surgery that could remove his entire bladder and prostate.

After bladder removal, normally patient cannot pass urine through his or her normal passage. Hence, a special type of bag system is attached to the tummy skin where urine accumulates. 

But for this patient the radical cystoprostatectomy with orthotopic neobladder reconstruction surgery was performed in which a new bladder was constructed with a segment of small intestine (ileum) after the removal of bladder.

During the surgery, one and a half feet of small intestine was cut and isolated from the remaining intestine keeping intact its blood circulation. Besides, Continuity of the remaining intestine was restored and then the isolated segment of the intestine was folded and stitched in a special technique to make a neobladder. 

Both the ureters (tube which carry urine from kidney to bladder) implanted to the newly constructed bladder were connected to the original urethra (through which we pass urine) from inside and there was no artificial bag to fit on the skin. 

As a result, the patient's urine is now coming out normally through normal passage and patient no longer needs to carry extra urine bag. 

Even after a long duration surgery and having diabetes, hypertension with other complex heart diseases, it was possible to transfer the patient directly to the cabin rather than ICU. 

Radical cystoprostatectomy with orthotopic neobladder reconstruction surgery is a rare surgery and requires experienced and skilled surgery team support, said Dr MA Zulkifl. 

"Earlier, patients had to go abroad for availing such type of surgeries, but now we are doing this type of surgery in our country with great success," he added.