The Regenerating Bladder

For years, doctors have known that the urinary bladder, more than any other organ in the human body, possesses remarkable powers of regeneration, e.g., after removal of a diseased section, the bladder grows right over the incision to become intact. But until recently doctors did not know how to take complete advantage of this unique power.

Compared with other more complex organs, the bladder has a relatively simple structure and function. It is a remarkably elastic, muscular sac lying in the pelvic cavity. It receives urine from the kidneys through two slender tubes called ureters, expands to pint or even quart size as it stores urine, then contracts and discharges it from the body through a third tube called a urethra. People with no bladders, or with diseased bladders, usually live in great discomfort and with considerable danger of serious kidney infection.

Temporary Short Cut. B.C.M., a 50-year-old office manager, was a case in point. When he entered Detroit's Henry Ford Hospital, he had drained his bladder through artificial tubes for 27 years, suffered almost constant pain from chronic ulcers of the bladder. This week B.C.M. was ready to leave the hospital with a bladder as new as an infant's, as the result of a remarkable operation that causes the patient to grow a completely new bladder after the old one has been removed.

In 1950 three surgeons--Dr. Arthur Waite Bohne, chief of the Department of Urology at Ford, Dr. Paul Jackson Hettle of his staff, and Dr. Robert Wallace Osborn--began experimenting on dogs, succeeded in regenerating completely removed bladders by introducing a plastic mold around which a new bladder could grow. The technique worked so well that they decided to try it on humans.

Instead of a mold, which has to be removed in a second operation, the doctors used a three-by-four-inch. egg-shaped plastic bag. They removed B.C.M.'s diseased bladder, severing the ureters and the urethra where they entered the bladder, and put the inflated bag in its place. A Y-shaped tube ran through the bag. Its two arms were inserted through the dangling ureters to the kidneys and its trunk was passed through the urethra and outside the body through an incision (necessary only in males). This short cut from the kidneys permitted B.C.M. to live without a bladder while a new one was growing.

New Tissue. From their previous experiments and from X rays, the doctors charted the growth of the regenerating organ. Almost immediately after B.C.M.

was sewed up, his body began reacting, building up a thick-walled pouch around the plastic bag. In 30 to 50 days, the pouch had completed the first of three distinct layers of tissue, and at the end of 90 days the smooth muscle tissue that discharges the bladder at will had been formed. Meanwhile, the pouch had adhered to the surrounding body tissues and to the severed ends of the ureters and urethra.

B.C.M. now had a perfectly healthy (although slightly smaller) new bladder. The plastic bag was deflated and, with its tubes, pulled out through the urethra and the incision without further surgery. Since the operation had not touched the small sphincter muscle that opens and closes the entrance to the urethra, the patient had no difficulty in controlling his new bladder.

New Strength. The origin of the regenerated tissue posed an interesting question. Some layers were probably the result of the body's normal healing process, and others may have been formed from blood cells; connective tissue undoubtedly was formed from the ureters and urethra. But the appearance of smooth muscle in the pouch was, in the words of the doctors, "more difficult to rationalize" : true regeneration of smooth muscle has been observed only in rare situations, and mostly in animals. After considering several possible sources, doctors could only conclude that the smooth muscle in the new bladder may somehow have been formed from the primitive connective tissue.

Patients who need new bladders are not likely to worry much where they come from. The new operation spells hope for thousands afflicted with such common bladder ailments as cancer or chronic ulcers. "It's by no means a panacea for everybody with bladder trouble," says Dr. Bohne. "But the new procedure will replace the reservoir and will, we believe, prevent the kidneys from becoming infected, a result that frequently caused untimely deaths after the older method of radical surgery and the insertion of permanent catheters [artificial drainage tubes] into the kidneys. And if, for example, we can eradicate a cancer that is causing trouble, we're giving the patient a better chance of survival."

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