The first urine his body had made in seven years
On May 4, 2025, surgeons at UCLA and USC crossed a threshold that medicine had never before reached, transplanting a human bladder into a living patient and restoring a function — the simple, private act of producing urine — that the man had lost to cancer and kidney failure seven years prior. The procedure, combining a kidney and bladder transplant in a single eight-hour operation, offers a glimpse of an alternative path for the millions who live with terminal bladder disease, one that bypasses the long complications of intestinal reconstruction. As with all first steps, the ground ahead is uncertain, but the door, once sealed, is now open.
- A man spent seven years tethered to a dialysis machine three times a week, his body unable to produce a single drop of urine on its own — a quiet, grinding medical captivity.
- Surgeons Inderbir Gill and Nima Nassiri spent over four years preparing for a procedure no one had ever successfully attempted, navigating vascular complexity, regulatory hurdles, and the anatomical puzzle of the human pelvis.
- The moment the transplanted kidney connected to the new bladder and began to work, it released a large volume of urine — the patient's first in seven years — signaling that the gamble had paid off.
- The patient walked out of surgery free from dialysis, but the medical community now watches carefully: immune rejection, lifelong drug dependency, and long-term organ function remain open and consequential questions.
- The procedure currently applies only to a narrow group — patients already requiring transplants — but its success reframes what is possible for millions living with severe bladder disease worldwide.
On May 4, 2025, surgeons Inderbir Gill of USC and Nima Nassiri of UCLA completed an eight-hour operation at Ronald Reagan UCLA Medical Center that had never before been performed on a living human: a bladder transplant. The patient had lost his bladder to cancer surgery seven years earlier, and when his kidneys subsequently failed, he became dialysis-dependent — bound to a machine three times a week, unable to produce urine on his own.
The surgical team chose to address both failures simultaneously, transplanting a new kidney first and then a new bladder, connecting the two. When the kidney began to function, it sent a large volume of urine into the new bladder — the first urine the patient's body had made in seven years. He left surgery free from dialysis for the first time in nearly a decade.
The significance reaches well beyond one man's recovery. Millions worldwide suffer from terminal bladder disease, and the current standard of care — harvesting intestinal tissue to reconstruct a bladder or urinary conduit — carries a long trail of complications including chronic infections, kidney deterioration, and digestive problems. A transplanted bladder, being a real organ, sidesteps those risks, though it introduces its own: lifelong immunosuppression and the ever-present threat of rejection.
Gill and Nassiri did not arrive at this moment quickly. More than four years of preparation went into the surgery — cadaveric practice, pioneering robotic retrieval techniques, regulatory approval, and a formal clinical trial. Now the harder work begins: monitoring how the transplanted organ performs over time, how much immune suppression the patient will require, and whether rejection emerges as a complication. The answers will come slowly, through this patient and those who follow. For now, a procedure once considered impossible has been performed — and the questions it raises are as significant as the milestone itself.
On May 4, 2025, surgeons at Ronald Reagan UCLA Medical Center completed a procedure that had never been attempted in a living human before: they transplanted a bladder. The operation, performed by Inderbir Gill of USC and Nima Nassiri of UCLA, took roughly eight hours and marked the culmination of more than four years of planning, practice, and regulatory work.
The patient had endured a particular kind of medical catastrophe. Seven years earlier, he underwent surgery to remove bladder cancer, a procedure that left him with only a small, damaged remnant of the organ. Years later, both his kidneys failed, likely from the same disease process. He became dialysis-dependent, tethered to a machine three times a week to filter his blood. His bladder, what remained of it, could no longer function. He could not produce urine on his own.
Gill and Nassiri decided to address both problems at once. They transplanted a new kidney first, then a new bladder, connecting the kidney to the newly grafted organ. The moment the transplanted kidney began to work, it produced a large volume of urine—the first urine this patient's body had made in seven years. The new bladder received it without complication. The patient walked out of surgery free from dialysis for the first time in a decade.
Why this matters extends beyond one patient's relief. Millions of people worldwide live with severe bladder disease. Some develop what doctors call terminal bladders—organs that no longer function, that cause constant pain, that spawn recurring infections. The standard treatment has been to harvest a section of the patient's intestine and fashion it into a replacement bladder or a conduit for urine to leave the body. These surgeries work, but they carry a long shadow of complications: chronic infections, declining kidney function, digestive problems that accumulate over years.
A transplanted bladder, by contrast, is a real bladder. It behaves like the organ it is. It avoids the cascade of intestinal complications. But transplantation carries its own burden: the body's immune system will attack the foreign organ unless suppressed with drugs for life. Those drugs bring their own risks. For now, the procedure makes sense only for patients who already need an organ transplant—or, like this man, who need two.
Gill and Nassiri did not arrive at this surgery unprepared. They spent years practicing on deceased donors, perfecting the technique of harvesting a bladder and implanting it. They performed the first-ever robotic bladder retrievals. They worked through the vascular complexity of the pelvis, the anatomical puzzle that had prevented anyone from attempting this before. They secured regulatory approval. They built a clinical trial.
Now comes the harder part: watching. The unknowns are substantial. How well will the transplanted bladder function over months and years? How much immunosuppression will the patient ultimately need? Will rejection become a problem? These questions will be answered slowly, through this patient and those who follow. Gill and Nassiri have said they hope to perform more bladder transplants in the near future. For now, they have opened a door that was closed. What lies beyond it remains to be seen.
Notable Quotes
This surgery is a historic moment in medicine and stands to impact how we manage carefully selected patients with highly symptomatic terminal bladders that are no longer functioning.— Dr. Inderbir Gill, USC Urology
For the appropriately selected patient, it is exciting to be able to offer a new potential option.— Dr. Nima Nassiri, UCLA Urology
The Hearth Conversation Another angle on the story
Why couldn't surgeons do this before? It seems like a straightforward transplant.
The pelvis is anatomically dense—blood vessels, nerves, and organs all packed tightly together. The bladder has a complicated vascular structure. No one had figured out how to safely remove it from a donor and implant it in a recipient without damaging those vessels or losing function.
So this patient had both kidneys fail and his bladder destroyed. That's an unusual combination.
It is. But it's also what made him a candidate. He was already facing a lifetime on dialysis. A kidney transplant alone wouldn't restore his ability to urinate. A bladder transplant alone wouldn't help his kidneys. Together, they gave him back something he'd lost: the ability to produce urine naturally.
The surgeons mention that immunosuppression is the real limiting factor. Why can't they just give everyone a bladder transplant?
Because the drugs that prevent rejection have serious side effects over time. They increase infection risk, can damage the kidneys you just transplanted, and carry other long-term costs. It only makes sense if you're already committed to taking those drugs for another organ.
What happens if this patient's body rejects the bladder?
That's one of the unknowns they're watching for. If rejection occurs, they'd likely need to remove the transplanted bladder and return to the old standard treatment—using a piece of intestine to create a new urinary reservoir.
Is this a cure, or just a different way to manage the problem?
It's a different way—potentially a better one for the right patient. It doesn't cure bladder disease. But for someone with a terminal bladder, it offers a more physiologic solution than reconstructing one from intestine, which comes with its own set of lifelong complications.
What's the next step?
More patients, more time, more data. They need to see how this bladder performs over years, not months. They need to understand the immunosuppression requirements. They need to refine the technique. This is the first step in a much longer journey.