An orthotopic neobladder is an internal urinary diversion where a segment of the small intestine is used to form a new (neo) reservoir for urine. The ureters are attached to the neobladder, as is the urethra, allowing voiding to be done through the natural course.
During the procedure, your surgeon will use a piece of intestine to create a new bladder that allows you to urinate voluntarily and maintain continence.
Some reasons where people have their bladders removed include:
- Bladder cancer
- Nonfunctional bladder caused by radiation therapy, neurologic conditions or chronic inflammatory disease
- Urinary incontinence that has not responded to other treatment
- Birth defects that cannot be repaired
- Trauma to the bladder
To create a neobladder, your surgeon will first remove 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 both into a sphere, which becomes the neobladder.
Your surgeon will place 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 will be attached to your urethra. This allows you to maintain urinary control with a functional bladder that is capable of storing urine without the need for external bags or appliances.
After the surgery
The hospital stay after neobladder reconstruction will be usually about three to five days.
As with any bladder substitute, it may take some time until the neobladder works best. Immediately after surgery, many people can have difficulties with urinary incontinence until the neobladder stretches to a normal size and the muscles that support it get stronger.