Earlier this month, physicians in Southern California performed the first ever bladder transplant. Dr. Valentin Shabtayev, from Rambam Health Care Campus (Rambam) weighs in.
Oscar Larrainzar (41) lost most of his bladder when doctors removed a cancerous tumor, leaving the remaining portion nonfunctional. He subsequently required another surgery to remove both kidneys due to end-stage kidney disease and has been on dialysis for the past seven years.
As part of an innovative clinical trial, surgeons in Southern California performed the first human bladder transplant. The complex surgery began when surgeons retrieved a kidney and bladder from an organ donor, transplanted them into Larrainzar, and then connected both using a surgical technique they developed. Shortly after the eight-hour surgery, the patient’s kidney function improved, allowing him to come off dialysis.
“On the surface, the surgery was a success however, it remains unclear whether the new bladder will fully function. Questions remain about the risks of organ rejection, the complexity of connecting blood vessels and nerves, and the absence of prior clinical experience,” says Dr. Shabtayev, director of the Neuro-Urology and Sexual Function Unit at Rambam.
Restoring nerve function presents a significant obstacle. The nervous system, guided by the brain, controls bladder function by allowing it to relax, fill with urine, contract, and empty. “The process relies on a complex network of nerves surrounding the bladder that must work in perfect coordination,” explains Shabtayev. “Because these nerves are microscopic in size, researchers have not yet been able to reconnect the body’s nervous system to the transplanted bladder, and they cannot guarantee normal bladder function.”
Patients with nerve damage or recurring urinary tract infections face an increased risk of developing serious bladder dysfunction, which often leads to terminal bladder disease. In these situations, doctors may need to enlarge or replace the bladder typically involving invasive surgery, limited bladder function, and significant personal and aesthetic challenges. Surgeons construct a ‘bowel diverter,’ or stoma, allowing urine to exit through a tube from the abdominal wall into an external drainage bag. Most patients find this option suitable. After any bladder surgery a catheter is inserted to drain the urine. Once the catheter is removed, doctors can determine if the bladder is functioning independently and the patient can urinate naturally.
“At Rambam, we perform robotic bladder resections at least once a month,” adds Shabtayev. “Most are caused by an invasive malignancy of the urinary tract. These cases require a bladder resection—removal of the malignancy and some surrounding healthy tissue to prevent the spread of the disease.”
When patients need an aesthetic solution, surgeons reconstruct the bladder using a pouch made from the patient’s intestine—an approach that avoids the risk of organ rejection. The reconstructed bladder functions similarly to a natural one, though complications can arise.
A bladder transplant has advantages: it keeps the urinary and digestive systems separate, has a more natural cosmetic outcome, and preserves body image. Is it an ideal solution? Only time will tell.
Based on a Hebrew article that first appeared on YNet
