Overview

Neobladder reconstruction is a surgical procedure to construct a new bladder.

After bladder removal surgery (cystectomy) for bladder cancer or another condition, your surgeon must create new way for urine to exit your body (urinary diversion). Neobladder reconstruction, also called orthotopic neobladder reconstruction, is one option for urinary diversion. During the procedure, your surgeon uses a piece of intestine to create a new bladder that allows you to urinate voluntarily and maintain continence.

Why it's done

You'll need neobladder reconstruction if you have your bladder surgically removed, or if it no longer functions properly. Some reasons that people have their bladders removed include:

• Bladder cancer
• Nonfunctional bladder caused by radiation therapy, neurologic conditions or chronic inflammatory disease
• Urinary incontinence that hasn't responded to other treatment
• Birth defects that cannot be repaired
• Trauma to the bladder

Risks

There are a number of complications that may occur with neobladder reconstruction, including:

• Bleeding
• Blood clots
• Infection
• Urine leaks
• Urine retention
• Electrolyte imbalances
• Vitamin B-12 deficiency
• Incontinence
• Cancer in the bowel

How you prepare

Food and medications

Your doctor may ask you to have a clear liquid diet for one to two days before surgery. And, usually, you'll need to stop eating and drinking after midnight on the night before your procedure. Let your doctor know about all of the medications, vitamins and dietary supplements you're taking. In some cases, you may need to stop these medications before your surgery.

Learning to self-catheterize

Urinary retention is a potential complication of neobladder reconstruction, so you need to be willing to put a catheter in (self-catheterization) to drain urine and relieve pressure on the bladder if this happens. A nurse or other health care professional will review this with you.

What you can expect

Before the procedure

Your doctor orders tests to check your kidney function and to make sure that you don't have a urinary tract infection. You may also have an imaging test, such as a CT scan, of your urinary tract to check the ureters — tubes that carry urine from the kidneys to the bladder — to see that they are in good condition.

During the procedure

To create a neobladder, your surgeon first removes your cancerous bladder (cystectomy) through either a traditional abdominal incision or with a robot-assisted laparoscopic approach (robotic surgery). Your surgeon then reshapes a section of your small intestine, colon or a combination of the two into a sphere, which becomes the neobladder.

Your surgeon places the neobladder in the same location inside your body as your original bladder. The neobladder is attached to your ureters so that urine can drain from your kidneys into the neobladder. The other end of the neobladder is attached to your urethra. This allows you to maintain urinary control with a functional bladder capable of storing urine without the need for external bags or appliances.

After the procedure

The hospital stay after neobladder reconstruction is usually about three to five days.

As with any bladder substitute, it may take some time until the neobladder functions best. Immediately after surgery, many people may have difficulties with urinary incontinence until the neobladder stretches to a normal size and the muscles that support it get stronger.

Daytime continence usually improves over the first three to six months after surgery, though it may continue improving for up to 12 months. Nighttime continence may take slightly longer, and can keep improving into the second year.

Lifelong follow-up is necessary after a neobladder reconstruction. Ask your doctor how often you should plan to return for follow-up visits.