Intestinal plasty of the bladder. Replacement of the bladder with the ileo-intestinal segment Treatment and plastic surgery of the bladder

04.03.2020 -

Plastic Bladder- it's forced surgical intervention, during which either the whole organ or part of it is completely replaced.

This operation is carried out only special indications when anomalies of the bladder do not allow the organ to perform all the necessary functions.

The bladder is a muscular hollow organ whose functions are to collect, store and excrete urine through the urinary ducts.

The organs of the urinary system

It is located in the small pelvis. The configuration of the bladder is completely different, depending on the degree of its filling with urine, as well as on the adjacent internal organs.

It consists of the top, body, bottom and neck, which gradually narrows and smoothly passes into the urethra.

The upper part is covered with peritoneum, which forms a kind of notch: in males it is rectal-vesical, and in females it is vesico-uterine.

In the absence of urine in the body, the mucous membrane is collected in a kind of folds.

The sphincter of the bladder provides control of urinary retention, it is located at the junction of the bladder and the urethra.

bladder at healthy person allows you to collect from 200 to 400 ml of urinary fluid.

Outside temperature environment and its humidity can affect the amount of urine excreted.

The excretion of accumulated urine occurs when the bladder contracts.

However, when pathologies occur, the mechanism for performing the basic functions of the bladder is seriously impaired. This forces doctors to decide on plastic surgery.

Causes

The need for plastic surgery of the bladder arises in cases where the organ has ceased to perform the functions intended for it by nature, and medicine is powerless to restore them.

Most often, such anomalies affect the mucous membrane of the bladder, its walls, as well as the neck of the urethra.

There are several diseases that can cause such pathologies, among which the most common are bladder cancer and exstrophy.

The main cause of organ cancer is bad habits, as well as some chemical compounds.

Pathology of the bladder

Tumors found with small size, allow for sparing operations to truncate them.

Unfortunately, large tumors do not allow you to leave the bladder, doctors have to decide on its complete removal.

Accordingly, after such a procedure, it is important to perform a replacement bladder plastic surgery, which makes it possible to ensure the functioning of the urinary system in the future.

Exstrophy is detected in the newborn immediately.

Such a pathology is not subject to treatment at all, the only possibility for the baby is to undergo a surgical intervention involving plastic surgery, during which the surgeon forms an artificial bladder capable of performing its intended functions without obstacles.

Technique

Exstrophy, which is a serious pathology that simultaneously combines anomalies in the development of the bladder, urethra, abdominal wall and genital organs, is subject to immediate plastic surgery.

Newborn treatment

This is also explained by the fact that most of the urinary organ has not formed, is missing.

A newborn undergoes bladder plastic surgery approximately 3-5 days after birth, because a child simply cannot live with such an anomaly.

Such a surgical intervention involves a phased plastic surgery. Initially, the bladder is placed inside the pelvis, then it is modeled, eliminating anomalies of the anterior and abdominal walls.

To ensure normal retention of urine in the future surgically reduce the pubic bones. They form the neck of the bladder and the sphincter, thanks to which it is possible to directly control the process of urination.

In conclusion, a ureteral transplant is mandatory to prevent reflux, when urine is thrown back into the kidneys. The operation is quite complicated, the only consolation is that the pathology belongs to the category of rare ones.

Bladder plastic surgery

Plastic surgery is also necessary in the case when the patient underwent a cystectomy upon detection of a cancerous disease. After complete removal bladder replacement organ can be created from part small intestine.

An artificial reservoir for collecting urine can be formed not only from the intestine, but in a complex from the stomach, rectum, small and large intestines.

As a result of such plastics, the patient has the opportunity to control urination independently.

Also, plastic surgery allows to provide the most natural process of urination, during which a section of the small intestine is brought to the ureter and urethra, successfully connecting them.

Postoperative recovery

For several days, the patient is forbidden to eat to ensure a good flushing (disinfection) of all urinary organs.

Postoperative recovery

To maintain physical strength, intravenous nutrition is carried out. The postoperative period after plastic surgery lasts about two weeks, after which the drains, installed catheters are removed, and the sutures are removed.

It is from this moment that it is allowed to return to natural nutrition and physiological urination.

Unfortunately, the urination process itself is somewhat different from the physiological one. In a healthy bladder, the output of urine to the outside is carried out by muscle contractions of the bladder.

After plastic surgery, the patient will have to push and press on the abdominal part of the abdomen, under the influence of which urine will be released, and the artificial reservoir will be emptied.

To prevent infection of the urinary system, it is important to empty every three hours immediately after plastic surgery, and after six months - every 4-6 hours.

There are no natural urges, therefore, if such requirements are not observed, excessive accumulation of urine can occur, leading in many cases to rupture.

Urine after plastic surgery becomes cloudy because the intestines from which the reservoir was created continue to secrete mucus.

The blockage of the urinary ducts with this mucus can become a danger, so the patient is recommended to take lingonberry juice twice a day. One more the most important recommendation is the use a large number water.

The invention relates to medicine, urology, and can be used for plastic surgery of the bladder after its removal. A U-shaped intestinal reservoir is formed from the graft ileum. The graft is dissected along the antimesenteric edge. In the resulting rectangle, the long shoulder is bent in the middle. The edges are combined and sutured from the mucosal side with a continuous suture. Match opposite long sides. Get a U-shaped tank. The edges of the Komi graft are compared and sutured for 4-5 cm. The ureters are anastomosed with a formed reservoir. Form the urethral tube. At the same time, the lower lip of the graft is moved towards the urethra. Connect the upper lip and two points of the lower lip with a triangular seam. A urethral tube is formed from the formed flap. A Foley catheter is passed into the graft through the urethra. The ureteral stents are withdrawn in the opposite direction. Anastomose the urethral tube with the urethra. The edges of the graft are matched with adaptive sutures. The method allows to prevent the failure of the anastomosis between the reservoir and the urethra. 12 ill., 1 tab.

The invention relates to the field of medicine, urology, specifically to methods of orthotopic intestinal plastics of the bladder and can be used after bladder removal operations.

Known methods of orthotopic plastics, aimed at diverting urine into the intestine, date back to the middle of the 19th century. Simon in 1852 diverted urine from a patient with exstrophy of the bladder by moving the ureters into the rectum, thus achieving retention of urine using the anal sphincter. Until 1950, this urinary diversion technique was considered the leading one for patients who required urinary diversion with retention. In 1886, Bardenheüer developed the methodology and technique for partial and total cystectomy. A known method is ureteroileocutaneostomy (Bricker) - diversion of urine on the skin through a mobilized fragment of the ileum. On the long time this operation has been the gold standard for diversion of urine after radical bladder surgery, but the solution to this problem is far from being resolved to date. The method of removing the bladder must end with the formation of a well-functioning urinary reservoir. Otherwise, a number of complications associated with urinary incontinence develop, leading to a deterioration in the quality of life of the patient.

The closest to the proposed method in terms of technical implementation is the method of forming a U-shaped tank low pressure from a fragment of the ileum, performed after radical cystectomy, including radical cystectomy, formation of a U-shaped reservoir from 60 cm of the terminal ileum after detubularization and reconfiguration of the intestinal graft, formation of a hole at the lowest point of the graft to form an anastomosis between the urethral stump and the formed intestinal graft . However, in the event of destruction due to heavy pathological condition anatomical formations responsible for urinary retention, when forming a reservoir using this method, complications are observed, consisting in urinary incontinence. Since one of the difficult stages of the operation, given anatomical features the location of the urethra is the formation of an anastomosis between the reservoir and the urethra, the failure of the anastomosis leads to leakage of urine in the early postoperative period and the development of a stricture of the enterocystourethral anastomosis in the late postoperative period, Table 1.

A new technical challenge is the prevention of intraoperative, postoperative complications and improving the quality of life of patients after operations associated with the removal of the bladder.

The problem is solved by a new method of orthotopic intestinal plastics of the bladder, which consists in the formation of a U-shaped intestinal reservoir of low pressure from the transplant of the terminal ileum and the channel for urine diversion, and the channel is a urethral tube 5 cm long, which is formed from the distal lip of the intestinal reservoir , for which the lower lip of the graft is moved towards the urethra and connected to the upper lip at two points of its lower lip with an angled suture, forming a flap, when the edges of the graft are sewn together with a single-row serous-muscular suture, the urethral tube is formed, after which the mucosa of its distal end is turned outward and fixed with separate sutures to the serous membrane of the graft, after which a three-way Foley catheter is passed through the urethra and the formed urethral tube, and external ureteral stents are removed from the intestinal reservoir in the opposite direction, then anastomosis is performed with 4-6 ligatures for 2, 4, 6, 8, 1 0, 12 hours, after that, the edges of the right and left knees of the graft are compared with interrupted adapting L-shaped sutures, after which the anterior wall of the intestinal reservoir is fixed to the stumps of the pubovesical, puboprostatic ligaments or to the periosteum of the pubic pubic by separate sutures from a non-absorbable thread.

The method is carried out in the following way.

The operation is performed under endotracheal anesthesia. Median laparotomy, perform a typical radical cystectomy and lymphadenectomy. If the conditions of the radical nature of the operation allow, the neurovascular bundles, the ligamentous apparatus of the urethra, and the external striated sphincter are preserved. Perform mobilization of 60 cm of the terminal ileum, retreating 20-25 cm from the ileocecal angle (Figure 1). With a sufficient length of the mesentery, as a rule, it is enough to cross the artery of the arcade vessels closest to the wall of the intestine, but at the same time they try to keep straight vessels, while dissecting the mesentery to a length of 10 cm, which is sufficient for further actions. The free abdominal cavity is delimited from the possible ingress of intestinal contents with 4 gauze napkins. The intestinal wall is crossed at a right angle with preliminary ligation of the vessels of the submucosal layer. patency gastrointestinal tract restore by imposing an interintestinal anastomosis between the proximal and distal ends of the intestine - "end to end" with a two-row interrupted suture, so that the formed anastomosis is above the mesentery of the mobilized intestinal graft. The proximal end of the graft is clamped with a soft clamp and a silicone probe is inserted into the intestinal lumen, through which a warm 3% solution is injected boric acid to remove intestinal contents. After that, the proximal end of the graft is released from the clamp and straightened evenly on the probe. Scissors dissect the intestinal graft strictly along the antimesenteric edge. From the fragment of the intestine, a rectangle is obtained, having two short and two long arms. On one of the long arms, a point is isolated strictly in the middle, around which the long arm is bent, the edges are combined, and from the mucosal side, a continuous through, twisting (according to Reverden) suture is sutured (Figure 2). Further, opposite long sides are combined so that a U-shaped tubular reservoir is obtained. This stage is the main one in this method and it consists of a number of actions. The first action consists in matching and suturing for 4-5 cm the edges of the right and left knees of the resulting graft (Figure 3). The second step is to anastomose the ureters with the intestinal reservoir with antireflux protection on ureteral external stents (Figure 4). The third action is to form the urethral tube by moving the graft towards the urethra of the lower lip, connecting upper lip and two points of the lower lip of the graft with an angled suture, so that a flap is formed (Figure 5; 6), by suturing the edges of which a urethral tube 5 cm long is formed with a single-row interrupted suture, the mucosa of the distal end of the tube is turned outward and fixed with separate sutures to the serous membrane of the graft ( Fig.7). A three-way Foley catheter is inserted into the graft through the urethra and the formed urethral tube, and external ureteral stents are removed from the reservoir in the opposite direction. The fourth action is (in the imposition of an anastomosis) in the anastomosis of the urethral tube with the urethra, which is performed with 4-6 ligatures for 2; 4; 6; eight; 10 and 12 o'clock of the conventional dial. The fifth action is to match the edges of the right and left knees of the intestinal graft to a triangular suture, given that the lower lip is shorter than the upper lip, the comparison is made with interrupted adaptive L-shaped sutures (Fig.8). The sixth action - to prevent possible displacement of the graft and deformation of the urethral tube with separate sutures from a non-absorbable thread, the anterior wall of the reservoir is fixed to the stumps of the pubovesical, puboprostatic ligaments or to the periosteum of the pubic bones. The size and shape of the graft in general view shown in Fig.9.

Justification of the method.

The main criteria for the surgical technique of radical cystectomy, under which the likelihood of urinary incontinence after the formation of the intestinal reservoir is minimal, is the maximum possible preservation of the anatomical formations of the urethra and neurovascular complexes. However, in a number of cases: with locally advanced forms of tumor lesions of the bladder, after previously undergone surgical interventions on the pelvic organs, after radiotherapy small pelvis, the preservation of these formations becomes an impossible task, and therefore the likelihood of urinary incontinence increases significantly. In addition, one of the difficult stages of the operation, given the anatomical features of the location of the urethra, is the formation of an anastomosis between the reservoir and the urethra. The failure of the anastomosis leads to leakage of urine in the early and development of stricture enterocystourethral anastomosis in the late postoperative period. These complications can be reduced if favorable conditions anastomosis formations that are created during the formation of the urethral tube. The formed reservoir does not interfere with the conduction and tightening of ligatures from the formed tube. The formation of the urethral tube from the graft wall allows you to maintain adequate blood circulation in the wall of the urethral tube, and to prevent possible displacement of the graft and deformation of the urethral tube, it is fixed with separate sutures from a non-absorbable thread to the anterior wall of the reservoir to the stumps of the pubovesical, puboprostatic ligaments or to the periosteum pubic bones. The result is a triple urinary continence mechanism.

Example: Patient A. 43 years old. Appealed to the urology department in the order of planned care with a diagnosis of bladder cancer, the condition after combined treatment. In anamnesis, the patient was diagnosed 6 years ago at the time of admission. During the follow-up, the following operations were performed: bladder resection and two times TUR of a bladder tumor. Two courses of systemic and intravesical chemotherapy, one course of external beam radiation therapy. At the time of admission, clinically shriveled (effective bladder volume is not more than 50 ml), pronounced pain syndrome frequency of urination up to 25 times a day. The diagnosis was confirmed histologically. Conducted instrumental methods examinations: ultrasound of organs abdominal cavity, CT scan of the pelvic organs, isotope bone scintigraphy, radiography of organs chest- data for distant metastases were not received. Given the recurrence of the disease, the changes that developed in the bladder, which significantly worsened the patient's quality of life, it was decided to perform a radical operation. However, given the nature of the developed complications, it was decided to perform a two-stage treatment option. The first step is to perform a radical cystectomy with ureterocutaneostomy, and the second step is an orthotopic intestinal plasty Bladder. The first stage of the operation was completed without severe complications, after a three-month rehabilitation, the patient underwent orthotopic plastic surgery of the bladder. Taking into account the fact that during the first stage of the operation there was no possibility of preserving the neurovascular bundles and the external striated sphincter and ligamentous apparatus of the urethra, the variant of plastic surgery was chosen as the option of forming an intestinal reservoir with an additional mechanism for urinary retention - a U-shaped reservoir of low pressure with the formation of a urethral tubes. The operation was performed without technical difficulties, without complications in the early postoperative period. The ureteral catheters were removed on the 10th day, and the urethral catheter - on the 21st day. Up to 3 months after the operation, nighttime urinary incontinence persisted (despite the fact that the patient strictly followed all the recommendations). Subsequently, adequate urination was restored. The patient returned to his previous work. When the stage examination after 12 months noted the achievement of the capacity of the intestinal reservoir up to 400 ml at a maximum urine flow rate of 20 ml/s (Fig.10). When conducting retrograde urethrography, a typical structure of the urinary reservoir is noted (Fig.11; 12).

This method of treatment was used in 5 patients, all men. Average age was 55.6 years (from 48 to 66). Three patients were operated on in a multi-stage manner, and two patients were operated on in one stage. The duration of observation reaches 18 months. All patients have urinary retention day and night. One patient, 66 years old, could not empty the reservoir completely up to 4 months after the operation, which required regular catheterization of the urinary reservoir, and subsequently independent adequate urination was restored. One 53-year-old patient developed a stricture of the vesicourethral anastomosis 6 months after the operation. This complication eliminated by optical urethrotomy. Most frequent complication is a violation of erectile function, observed in 4 patients.

Thus, the proposed method can be successfully used in a contingent of patients suffering from bladder lesions requiring radical operation, during which it is not possible to save the anatomical structures responsible for urinary retention, orthotopic bladder plastics with additional urinary retention mechanisms are shown, one of which is the formation of a urethral tube according to the proposed method.

Table 1
List of complications after the formation of urinary reservoirs from various parts of the gastrointestinal tract (excluding cardiovascular and pulmonary complications)
	R	P
1	Urine leakage	2-14%
2	Urinary incontinence		0-14%
3	Intestinal failure	0-3%
4	Sepsis	0-3%	0-3%
5	Acute pyelonephritis	3%	18%
6	wound infection	7%	2%
7	Wound eventration	3-7%
8	Gastrointestinal bleeding	2%
9	Abscess	2%
10	Intestinal obstruction	6%
11	Bleeding of the intestinal reservoir	2%	10%
12	Intestinal obstruction	3%	5%
13	ureteral obstruction	2%	6%
14	Parastomal hernia		2%
15	Stenosis of the entero-ureteral anastomosis	6%	6-17%
16	Stenosis of the entero-urethral anastomosis		2-6%
17	Stone formation		7%
18	Reservoir overstretch		9%
19	metabolic acidosis		13%
20	reservoir necrosis		2%
21	Volvulus		7%
22	reservoir stenosis		3%
23	Entero-reservoir fistula		<1%
24	External intestinal fistula	2%	2%

Literature

1. Matveev B.P., Figurin K.M., Koryakin O.B. Bladder cancer. Moscow. "Verdana", 2001.

2. Kucera J. Blasenersatz - operationen. Urologische operationslehre. Lieferung 2. 1969; 65-112.

3. Julio M. Pow-Sang, MD, Evangelos Spyropoulos, MD, PhD, Mohammed Helal, MD, and Jorge Lockhart, MD Bladder Replacement and Urinary Diversion After Radical Cystectomy Cancer Control Journal, Vol.3, No.6.

4. Matveev B.P., Figurin K.M., Koryakin O.B. Bladder cancer. Moscow. "Verdana", 2001.

5. Hinman F. Operative urology. M. "GEOTAR-MED", 2001 (prototype).

A method for orthotopic intestinal plasty of the bladder, including the formation of a U-shaped intestinal low-pressure reservoir from a graft of the terminal ileum and a urine diversion canal, characterized in that to form a reservoir, the intestinal graft is cut along the antimesenteric edge, obtaining a rectangle having two short and two long arms, on one of the long arms, a point is selected in the middle, around which the long arm is bent, the edges are combined and from the mucosal side are sutured with a continuous through, twisting seam, then the opposite long sides are combined so that a U-shaped tubular reservoir is obtained, matched and sutured for 4-5 cm of the edge of the graft knees, the ureters are anastomosed with a formed reservoir with antireflux protection on the ureteral external stents, then the urethral tube is formed, for which the lower lip of the graft is moved towards the urethra, the upper lip and two points of the lower r are connected graft with a triangular suture so that a flap is formed, by suturing the edges of which a urethral tube 5 cm long is formed with a single-row interrupted suture, then the mucosa of the distal end of the tube is turned outward and fixed with separate sutures to the serous membrane of the graft, through the urethra and the formed urethral tube, a three-way Foley catheter, external ureteral stents are removed in the opposite direction, the urethral tube is anastomosed with the urethra with 6 ligatures for 2; 4; 6; eight; 10 and 12 o'clock of the conventional dial, the edges of the graft are compared to the triangular suture, given that the lower lip is shorter than the upper lip, the comparison is made with interrupted adaptive L-shaped sutures and then the anterior wall of the intestinal reservoir is fixed to the stumps of the pubovesical, puboprostatic ligaments or to periosteum of the pubic bones.

If the bladder has lost the ability to perform natural functions, and medicine is powerless to restore them, bladder plastic surgery is used.

Bladder plastic surgery is an operation, the purpose of which is the complete replacement of an organ or part of it. Most often, replacement surgery is used for oncological lesions of the organs of the urinary system, in particular, the bladder, and is the only way to save the patient's life and significantly improve its quality.

Types of preoperative examination

To clarify the diagnosis, determine where the lesion is located, determine the tumor size, the following types of studies are carried out:

Ultrasound of the pelvis. The most common and accessible study. Determines the size, shape, weight of the kidney.
Cystoscopy. With the help of a cystoscope inserted into the bladder through the urethra, the doctor examines the inner surface of the organ. It is also possible to take a scraping of the tumor for histology.
CT. It is used to clarify the size and location of not only the bladder, but also nearby organs.
Intravenous urography of the urinary tract. It makes it possible to find out the state of the overlying sections of the urinary tract.

Ultrasound examination makes it possible to identify the causes of pathology

The use of these types of research is not mandatory for all patients, they are prescribed individually. In addition to instrumental studies, blood tests are prescribed before the operation:

on biochemical indicators;
on blood clotting;
for HIV infection;
to the Wasserman reaction.

Urinalysis is also performed for the presence of atypical cells. If an inflammatory process is detected in the preoperative period, the doctor prescribes a urine culture with further antibiotic treatment.

Plastic surgery for exstrophy

Bladder exstrophy is a serious disease. In pathology, the absence of the anterior wall of the bladder and peritoneum is observed. If the newborn has bladder atrophy, surgery should be performed on the 5th day.

In this case, bladder plastic surgery consists of several operations:

At the first stage, the defect of the anterior wall of the bladder is eliminated.
The pathology of the abdominal wall is eliminated.
To improve the retention of urine, the pubic bones are reduced.
Form the neck of the bladder and sphincter to achieve the ability to control urination.
The ureters are transplanted to prevent reflux of urine into the kidneys.

Plastic surgery for exstrophy is the only chance for a newborn

Replacement treatment for tumors

If the bladder is removed, with the help of plastic surgery they achieve the ability to divert urine. The method of removing urine from the body is selected based on the following indicators: individual factors, the age characteristics of the patient, the state of health of the operated person, how much tissue was removed during the operation. The most effective plastic methods are discussed below.

Urostomy

A method for redirecting a patient's urine by a surgeon to an urinal on the abdominal cavity using a portion of the small intestine. After urostomy, urine exits through the formed ileal conduit, falling into a urinal attached near the hole in the peritoneal wall.

The positive aspects of the method are the simplicity of surgical intervention, the minimum time spent in comparison with other methods. After the operation, there is no need for catheterization.

The disadvantages of the method are: Inconvenience due to the use of an external urinal, from which a specific smell sometimes comes. Difficulties of a psychological nature about the unnatural process of urination. Sometimes urine flows back into the kidneys, causing infection and stone formation.

Method for creating an artificial pocket

An internal reservoir is created, to one side of which the ureters are attached, to the other - the urethra. It is advisable to use the plastic method if the mouth of the urethra is not affected by the tumor. Urine enters the tank in a similar way to the natural way.

The patient maintains normal urination. But the method has its drawbacks: occasionally you have to use a catheter to completely empty the bladder. Urinary incontinence is sometimes observed at night.

Formation of a reservoir for the withdrawal of urine through the abdominal wall

The method consists in the use of a catheter when removing urine from the body. The method is used when the urethra is removed. The internal reservoir is brought to a miniature stoma in the anterior abdominal wall. It makes no sense to wear a bag all the time, as urine accumulates inside.

Colon plasty technique

In recent years, doctors have spoken out in favor of sigmoplasty. In sigmoplasty, a segment of the large intestine is used, the structural features of which give reason to consider it more suitable than the small intestine. In the preoperative period, special attention is paid to the patient's intestines.

The diet of the last week restricts fiber intake, siphon enemas are given, enteroseptol is prescribed, and antibiotic therapy is carried out to suppress urinary infection. The abdominal cavity is opened under endotracheal anesthesia. An intestinal loop no longer than 12 cm is resected. The longer the graft, the more difficult it is to empty.

Before closing the intestinal lumen, it is treated with vaseline oil to prevent coprostasis in the postoperative period. The transplant lumen is disinfected and dried. If the site has a shrunken bladder and vesicoureteral reflux, the ureter is transplanted into an intestinal graft.

Replacement therapy is performed under general anesthesia

Recovery after surgery

During the first two weeks of the postoperative period, urine is collected into a reservoir through an opening in the abdominal wall. This period is necessary for healing of the place where the artificial bladder connects to the ureters and urinary canal. After 2-3 days, they begin to wash the artificial bladder.

For this purpose, physiological saline is used. Due to the involvement of the intestine in surgery, it is not allowed to eat for 2 days, which is replaced by intravenous nutrition.

After two weeks, the early postoperative period comes to an end:

drains are removed;
catheters are removed;
remove stitches.

The body moves on to natural food intake and urination processes. In the postoperative period, special attention is paid to the correctness of the process of urination. Urination passes with hand pressure on the anterior abdominal wall. Important! Overdistension of the bladder must not be allowed, otherwise there is a danger of ruptures, in which urine enters the abdominal cavity.

The first 3 months of the postoperative period, urination should occur every 2-3 hours around the clock. During the recovery period, urinary incontinence is characteristic, with the appearance of which it is necessary to immediately consult a doctor. At the end of the three-month period, urination is carried out after 4-6 hours.

A quarter of operated patients suffer from diarrhea, which is easy to stop: drugs are taken to slow down intestinal motility. According to doctors, no special lifestyle changes are required in the postoperative period. You just need to regularly monitor the processes of urination.

Optimism is the key to a quick recovery

Psychological rehabilitation

Within 2 months of the postoperative period, the patient is not allowed to lift weights, drive a car. At this time, the patient gets used to his new position, gets rid of fears. A particular problem in men after surgery is the restoration of sexual function.

Modern approaches to plastic technique take into account the need to preserve it. Unfortunately, it is not possible to give a full guarantee of the restoration of the functioning of the reproductive system. If sexual function is restored, then not earlier than in a year.

What to eat and how much to drink after surgery

In the postoperative period, the diet has minimal restrictions. Fried and spicy foods are prohibited, which accelerate blood flow, which slows down the healing of stitches. Fish and bean dishes contribute to the appearance of a specific smell of urine.

The drinking regimen after bladder plastic surgery should be changed in the direction of increasing the flow of fluid into the body. Daily fluid intake should not be less than 3 liters, including juices, compotes, tea.

Physiotherapy

Physiotherapy exercises should be started when the postoperative wounds heal, after a month from the day of the operation. The patient will have to engage in therapeutic exercises for the rest of his life.

Therapeutic exercise is an essential attribute of life after bladder plastic surgery

Exercises are performed to strengthen the pelvic floor muscles, which help to excrete urine. Kegel exercises are recognized as the most effective in rehabilitation after bladder plastic surgery. Their essence is as follows:

Exercises for slow muscle tension. The patient makes an effort similar to that of trying to stop urination. It should increase the increase gradually. At the maximum, muscle tension is held for 5 seconds. This is followed by a slow relaxation. The exercise is repeated 10 times.
Performing rapid alternation of muscle contractions and relaxations. Repeat exercise up to 10 times.

In the first days of physiotherapy exercises, a set of exercises is performed 3 times, then gradually increases. Plastic therapy cannot be considered as a complete deliverance from pathology. Bladder plastic surgery does not lead to a complete replacement of the natural one. But, if the advice of a doctor is strictly followed, there will be no deterioration in the state of the body. Over time, the implementation of procedures becomes an integral part of life.