A neobladder is a surgically constructed internal bladder replacement that allows individuals to store and pass urine through their natural urethra after their original bladder has been removed. This procedure is a type of orthotopic urinary diversion, meaning the new bladder is placed in the same anatomical position as the original bladder. The primary goal of a neobladder is to provide a way for urine to exit the body that closely mimics natural urination, avoiding the need for an external collection device.
Reasons for a Neobladder
The most common reason for creating a neobladder is the surgical removal of the bladder, known as a radical cystectomy, often necessitated by bladder cancer. This procedure is a standard treatment for muscle-invasive bladder cancer. In such cases, the entire bladder and often nearby lymph nodes are removed to ensure all cancerous tissue is eliminated.
Beyond cancer, a neobladder may be considered for other conditions that severely compromise bladder function and cannot be resolved by less invasive treatments. These can include severe bladder dysfunction, chronic inflammatory diseases, or neurological conditions that prevent the bladder from working properly. Additionally, some individuals with congenital anomalies or trauma to the bladder might also be candidates for this reconstructive surgery.
Creating a Neobladder
The surgical creation of a neobladder involves using a segment of the patient’s own intestine to form a new urine-holding pouch. Typically, a section of the small intestine, specifically the ileum, is used due to its suitability for reshaping and its capacity. In some instances, a portion of the large intestine may also be utilized. After the segment of intestine is carefully separated, the remaining ends of the intestine are reconnected to maintain digestive function.
The isolated intestinal segment is then reshaped into a spherical or pouch-like structure. One end of this newly formed pouch is connected to the ureters, which are the tubes that carry urine from the kidneys. The other end of the neobladder is then attached to the patient’s urethra, the natural channel through which urine exits the body.
How a Neobladder Works
Once surgically constructed and connected, the neobladder functions as an internal reservoir, collecting urine that flows from the kidneys through the ureters. Unlike a natural bladder, a neobladder lacks the same nerve endings that signal fullness, meaning patients do not experience the urge to urinate. Instead, individuals learn to recognize other sensations, such as pressure or fullness in the lower abdomen, to indicate when the neobladder needs to be emptied.
To empty the neobladder, patients employ a technique involving the relaxation of pelvic floor muscles combined with gentle abdominal pressure, often referred to as the Valsalva maneuver. This method helps to push urine out through the urethra, mimicking natural urination. While continence is achieved by many patients, particularly during the day, it requires conscious effort and training.
Life with a Neobladder
Adjusting to life with a neobladder involves a learning period as patients adapt to new ways of managing urinary function. This adjustment involves establishing a timed voiding schedule, where the neobladder is emptied at regular intervals, typically every two to four hours initially, to prevent overfilling and to train the new reservoir. Nighttime incontinence can be a common challenge, especially in the initial months, as the neobladder may not yet have developed its full capacity or the patient is not awake to manage it.
The intestinal tissue used to create the neobladder continues to produce mucus, which can appear as pale threads in the urine and may require occasional flushing to prevent blockages or infections. Regular follow-up appointments are important to monitor for potential long-term complications, such as metabolic imbalances, which can occur due to the intestine’s continued absorption of chemicals from urine. Despite these adjustments, many individuals with a neobladder can achieve a good quality of life, resuming daily activities.