Times of India
23 November 2010
By Vishakha Sharma

Cancer patient undergoes neo bladder surgery, where his own intestinal tissues were used to make a bag to hold urine
Abbood Manthoor Abbas (55) was in Karbala, Iraq, when he started passing blood through his urine a year ago. Later, he was diagnosed with urinary cancer. Though local doctors could have operated on him and removed the bladder, it would have been a painful and expensive procedure.

Therefore, Abbas opted to come to Pune where he was given a brand new bladder – a neo bladder, by Pune’s chief urologist and the uro–oncologist Dr R K Shimpi in Ruby Hall Clinic on November 3. The surgery cost Rs 2.5 lakh. Abbas has now fully recovered.

Abbas was suffering from Hematuria (blood in the urine) for the past one year. A local doctor referred him to Dr Adel Al Najar and Dr Rashid Riyadh, both of whom are uro–cancer surgeons. They sent him for several tests – urine examination, ultrasound of the urinary bladder, a CT scan and the cystoscopy and the biopsy of the bladder tumour. He was then diagnosed with muscledeep urinary cancer of the bladder and was advised to undergo a surgery for the removal of the bladder followed by the Ileal Conduit. But when Abbas refused the painful conduit, the doctors referred him to Dr Shimpi.

When Mirror spoke to Abbas, he said, "I tried to have the surgery done in Iraq, but what was offered to me there was a Conduit. Since this treatment would have given me a painful life even after surgery, I did not go for it and instead came to Pune. I have no pain now and can urinate easily without any discomfort."

Speaking to Mirror, Dr Shimpi explained Abbas’ reluctance to undergo the Ileal Conduit, saying, "In the Ileal Conduit, a segment of the small intestine is isolated and the remaining part reconnected. The kidney tubes – ureters are then connected to this isolated segment of the small intestine. It is brought out, fixed to the abdominal wall and a plastic pouch bag attached to the stoma which collects the urine. This pouch is fixed to the lower abdomen by a sticker. This requires changing every few days or weeks when it comes loose. Bathing or any slightly rigorous activity can cause it to fall off, leading to urinary leaks and odour. These pouches are imported and therefore very expensive."

Dr Shimpi continued, "The urinary bladder has two main functions – it acts as a reservoir for storing the urine and squeezes automatically to empty the urine. The Neo Bladder is a bag–like structure created from the 60 cm segment of the small intestine. The kidney tubes (ureters) are then connected to this bag and the bag is connected to the urethra just proximal to the urinary valve (spincter) which controls the urine.

The neo bladder functions as a urinary reservoir. However, it lacks the contractile activity of the normal urinary bladder, hence the patient has to tighten his lower abdomen to squeeze the urine out through the neo bladder. Since the patient’s urinary valve is preserved, the patient has fair urinary control and knows exactly when to pass the urine after he gets the distension sensation." Abbas was operated on by Dr Shimpi after going through another series of tests – CT scan, cystoscopy and biopsies to confirm the diagnosis and to confirm that his urethra was free of the cancer.

"The surgery took six–and–a–half hours in which Abbas’s urinary bladder, prostate, seminal vesicle and the pelvic lymph nodes were removed," Dr Shimpi said.

The main advantages of the Neo Bladder technique are that the patient can go back to work within a short time, that there is no disfiguring, no bothering about the urinary bag or stoma complications and no odour The technique does not require expensive technology or equipment as the neo bladder is formed from the patient’s own intestine.

Speaking on urinary bladder cancer, Dr Shimpi said, "Hematuria and urinary frequency can be the main symptoms of urinary bladder cancer. Overall, 75,000 to 1 lakh patients develop bladder cancer annually in India and accounts for approximately 20,000– 30,000 deaths annually. Bladder cancer is primarily a disease of advanced age, usually when one is one’s 60s and 70s, though the number of cases is rising among the younger population, possibly due chemicals, smoking, and pollution."

How It Works
The neo bladder is a bag–like structure made from the part of the small intestine that is removed during surgery.The kidney tubes are connected to the bag and the bag connected to the urethra.The Neo Bladder functions as a urinary reservoir. Since the patient’s urinary valve is preserved, s/he has fair urinary control

I tried to have the surgery done in Iraq, but what was offered to me there was a Conduit. Since this treatment would have given me a painful life even after surgery, I did not go for it and instead came to Pune. I have no pain now and can urinate easily without any discomfort." – Abbood Manthoor Abbas, patient from Iraq

The surgery took ‘six–and–a–half hours in which Abbas’s urinary bladder, prostate, seminal vesicle and the pelvic lymph nodes were removed." who operated upon Abbood Manthoor Abbas