A neobladder is a new bladder made from a section of intestine for a patient who requires a total cystectomy, where the bladder is removed because of cancer, severe inflammation or infection, or other issues. Using a neobladder allows a patient to remain continent, as the replacement bladder works much like the original. This eliminates the need for using catheters or wearing a urine collection pouch, and usually contributes to a better quality of life after surgery for the patient. Not all people are candidates for this procedure, and when they are, they need to follow careful instructions to take care of themselves after surgery.
In the neobladder surgery, a doctor will remove the diseased or damaged bladder and inspect the neighboring tissues to make sure cancer or injury has not spread. The surgeon takes a section of the part of the bowel known as the ileum and turns it into a pouch, connecting the ureters, which are the tubes that drain from the kidneys, to the pouch. The neobladder attaches to the urethra, allowing patients to void their bladders normally.
For approximately three weeks after surgery, the patient will need to wear a catheter to drain the neobladder while it heals. After catheter removal, patients must urinate on a schedule. The neobladder does not have the same nerve endings as a true bladder, and thus patients don't experience the feeling of needing to urinate when it is full. Over time, they can space the time between urinations more and more, as the replacement bladder will grow and their continence will improve.
Immediately after the surgery, patients may experience incontinence while they adjust. Some choose to wear incontinence pads in case of accidents while they get used to the neobladder. Usually, the urinary diversion surgery is successful and the patient will not need to take precautions in case of incontinence for very long. The urologist who performs the surgery will want to see the patient for several follow-up appointments to make sure the urinary tract is working properly.
People with liver, kidney, or urethral disease will not be good candidates for this procedure. If a doctor is concerned about a patient's ability to care for the new bladder properly, this procedure may not be an option. In other cases, the surgeon will evaluate the patient carefully and discuss the surgery in detail to make sure the patient understands the care instructions. If surgery appears appropriate for the patient, the surgeon can schedule a date and perform the neobladder surgery.