In a complex surgery, a private hospital in Delhi reconstructed a bladder of a 17-year-old boy before he could go in for kidney transplant. The boy, Ravi Tomar, was born with a spinal cord defect which caused problems in his bladder and eventually led to his kidney failure. Doctors first recreated and enlarged Ravi’s bladder and trained him in emptying the bladder himself before the kidney transplant.
Challenged by three life-threatening problems, Tomar was fighting for life when he was admitted to BlK Super Speciality Hospital. Dr Aditya Pradhan, Sr Consultant, Urology and Renal Transplantation, said, “Ravi’s case was complex.
He was born with a spinalcord defect called Spina Bifida (Meningomyelocele). This condition weakened his bladder functions as the nerves supplying blood to the bladder were damaged by the defect. As a result of the bladder dysfunction, kidney got progressively damaged and led to its failure.”
Before admitting to hospital, Ravi’s parents had consulted several doctors. They had refused renal transplant due to the complexities involved. “When the patient was presented to the hospital, Ravi was in end-stage kidney disease. His urinary bladder was very small. He could retain only 20 ml urine and remained wet most of the time,” added Dr Pradhan.
Doctors said that there were other associated problems as well. “First the bladder needed reconstruction to increase its size to normal 400 ml, prior to the transplant. The new bladder or neobladder does not empty urine like a normal bladder.
The child had to be trained to insert a catheter into the neobladder and empty it himself. Ravi had to be trained for three months before he became adept at this critical maneuver. Inserting a catheter into the bladder to empty it can lead to urinary tract infection. This is especially dangerous in the post renal transplant phase when the body immunity is suppressed by medication to preserve the transplanted kidney,” explained the team of doctors at the hospital.
Doctors planned a special protocol and designed a three-stage intervention schedule. “The first stage involved reconstruction of the bladder from the bowel loops. In the second stage patient was trained to empty the bladder. And then in the third stage the kidney transplant was done successfully,” elaborated Dr Yajvender Pratap Singh Rana, Consultant, Urology and Renal Transplantation.
Entire procedure from bladder reconstruction to training Ravi for evacuating his bladder to kidney transplant took over four months. On Ravi’s recent visit to the hospital, Dr Pradhan informed that his kidney is functioning well and he has recovered fast.