100 - Urine for a Surprise: The First Human Bladder Transplant

Description: Description of Team:
The surgical team, led by surgeons Dr. Nima Nassiri (UCLA) and Dr. Inderbir Gill (USC) successfully performed the world's first Bladder Transplant at Ronald Reagan UCLA Medical Center. The surgeons collaborated for five years to develop surgical techniques that would lead to this momentous occasion. The surgical team members included circulating and scrub nurses with expertise in complex urology procedures as well as anesthesiologists.

Preparation and planning:
Months prior to the surgery, there were multiple conversations between the nursing and surgical teams to stay prepared for the upcoming procedure. There were also two full trial runs performed with the nursing team, surgeon and anesthesia team to discuss the sequence of events, including lines necessary and optimal layout of the operating room.

Assessment:
We assessed our gap analysis for instrumentation which led to both teams collaborating to create one specific tray that would contain the critical instrumentation to complete the case. In addition, a surgeon's preference card would need to be created to provide staff with the necessary sutures, supplies, and equipment needed (to ensure readiness). Current treatment for bladder cancer or dysfunction includes augmenting the urinary reservoir by using a portion of the patient's stomach to create a new bladder or creating a stoma as a pathway for urine excretion. These procedures can compromise the patient's health by disrupting their digestive tract, increasing occurrence of bacterial infections, and internal bleeding. The patient had lost most of his bladder during a tumor removal procedure, leaving the remaining bladder too small to function properly. Subsequently, his kidneys were also removed due to renal cancer, requiring him to undergo dialysis for seven years.

Implementation:
The nursing team was made aware and activated 48 hours in advance prior to the procurement. The surgeons successfully procured the kidney and bladder the May 3rd in the evening at an outside hospital. The kidney and bladder transplants were successfully performed on May 4th, 2025. The procedures concluded after eight hours, and the patient was then transferred to the surgical ICU.

Outcome:
Prior to the completion of the procedure, the patient's new kidney started producing urine, and his overall kidney function improved, allowing him to discontinue dialysis. After recovering in the hospital for nine days, the patient was successfully discharged home. During the patient's follow-up visit the urinary catheter was removed and he was able to feel urgency and voided successfully. Following the procedure, we discussed additional instruments and supplies that could be beneficial to have for the next bladder transplant. As the technique continues to evolve, the surgical team aims to advance toward the completion of bladder transplantation using a fully robotic approach.

Implications for perioperative nursing:
The success of this revolutionary procedure provides new and optimistic options for this unique group of patients who struggle with both kidney and bladder dysfunction. Performing the world's first bladder transplant has significantly elevated the profile of our department, positioning us at the forefront of surgical innovation. For perioperative nursing, this landmark procedure has expanded our scope of practice, highlighting the need for advanced clinical coordination, specialized training, and enhanced interdisciplinary collaboration.