What is Neobladder Reconstruction?
Neobladder reconstruction is a surgical procedure to construct a new bladder.
The neobladder is made from a piece of a person’s own small intestine that is formed into a pouch and positioned inside the body in the same position as the original bladder. With this procedure, most patients can void normally. There is usually a period of urinary leakage until the pouch stretches up and the patient strengthens the sphincter muscle that holds in the urine. Occasionally patients need to put in a catheter to drain the urine; this is more common in women than in men. Some patients also have persistent leakage, especially at night.
When is Neobladder Reconstruction needed?
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
What should you know before undergoing Neobladder Reconstruction?
Not everyone is a candidate for a neobladder reconstruction; for example, patients must have full kidney and liver function, and cannot have cancer in urethra. However, many patients prefer this type of diversion compared to an ileal conduit (external collecting bag that sticks to the abdominal wall).
What are the complications and side effects?
There are a number of complications that may occur with neobladder reconstruction, including:
- Blood clots
- Urine leaks
- Urine retention
- Electrolyte imbalances
- Vitamin B-12 deficiency
- Cancer in the bowel
It is important you understand the precautions and know the possible complication and side effects before having this Neobladder Reconstruction. If you have any questions, please consult with your doctor or surgeon for more information.
How do I prepare for Neobladder Reconstruction?
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.
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 happens during Neobladder Reconstruction?
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.
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.
What happens after Neobladder Reconstruction?
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.
If you have any questions or concerns, please consult with your doctor or surgeon for more information.
What should you do after Neobladder Reconstruction?
It takes time to get used to a new bladder. The neobladder will not have the nerves that tell you when your bladder is full and you will have to learn new ways to empty it. You’ll need to see a specialist to develop a toilet schedule to train your new bladder. At first, the capacity of the new bladder will be small and you will probably need to empty your bladder every 2–3 hours. This will gradually increase to 4–6 hours, but it may take several months. This may mean that the neobladder leaks when full, and you may have to get up during the night to empty the neobladder.
The nurse can also teach you how to drain your bladder with a catheter in case you can’t empty it completely using your abdominal muscles. This is called intermittent self-catheterisation.
Hello Health Group does not provide medical advice, diagnosis or treatment.