Orthotopic Neobladder

The neobladder reconstruction is a surgical procedure to construct a new bladder.

Once the bladder is removed due to bladder cancer(cystectomy) or any other conditions, the doctor will perform reconstructive surgery to create a new way for urine to exit from the body. There are several ways to create the route, one of those is the neobladder. Neobladder reconstruction is also known as orthotopic neobladder reconstruction. In this procedure, the doctor uses a piece of the intestine to create a new bladder which allows you to urinate and maintain continence.

It is done, if the bladder is removed surgically or if it is not functioning properly. A few reasons why people undergo this surgery include:

• Bladder cancer
• If the bladder becomes non-functional due to radiation therapy, neurologic conditions, or chronic inflammatory disease.
• If it's a birth defect that cannot be repaired further,
• Any accidents or trauma to the bladder.
• If you have urinary incontinence that has not responded to other treatments.

Advantages of neobladder:

The main advantage of the neobladder is that emptying urine from the neobladder is very similar to the normal process of urination to the other options of incontinent diversion (ileal conduit) and continent diversion (Indiana pouch reservoir).

Many complications occur with neobladder reconstruction such as,

• Bleeding
• Blood clots
• Infection
• May experience urine leakage last up to six months
• Some may have difficulty in fully emptying the neobladder using the abdominal muscles,
• Electrolyte imbalances
• B-12 vitamin deficiency
• Incontinence
• Retention of Urine

Before the procedure, the doctor will do tests

• to check your kidney function to make sure that there is no urinary tract infection,
• an imaging test like a CT scan is done to check your urinary tract to check the ureters.

During the surgery, the doctor will first remove the cancerous bladder (cystectomy) either through a traditional abdominal incision or with a robot-assisted laparoscopic approach (robotic surgery).

Then, the doctor creates a neobladder with a small part of your small intestine, colon, or a combination of the two into a sphere that becomes the neobladder. It is kept in the same place inside your body as your original bladder. The neobladder is attached to the ureters to drain urine from the kidneys into the neobladder and the other end is attached to the urethra. The urethra is a thin tube that connects to the bladder and allows the urine to pass out of the body.

This helps in maintaining urinary control with a functional bladder that is capable of storing urine without the need for external bags.

After the surgery:

The hospital stay will be around five days. With any bladder substitute, it will take some time for the neobladder to function properly. The patient may initially have difficulty with urinary incontinence till the neobladder gets to the normal size and supportive muscles become strong.

Incontinence may improve in three to six months after surgery, but night-time incontinence may take some more time. After neobladder reconstruction, a lifetime follow-up with the doctor is a must.