Neobladder Reconstruction

Overview

Neobladder reconstruction, also called orthotopic neobladder reconstruction, is a type of bladder reconstruction often used after removal of the original bladder. Surgeons take a section of the intestine to form a new bladder. The surgical team places the newly created bladder in the same spot as the natural bladder. There are several types of urinary diversion.

Type of Urinary Diversion	Description
Orthotopic Neobladder	Creates a new bladder at the natural location.
Ileal Conduit	Uses intestine to form a simple urine pathway.
Continent Urinary Diversion	Provides urine storage with voluntary emptying.

A neobladder allows most people to urinate voluntarily with improved control. This option is selected based on a patient’s overall health and personal preferences. Each type of urinary diversion has its own advantages and considerations, which should be carefully discussed with the care team.

Reasons for This Procedure

Surgeons perform neobladder reconstruction when the original bladder cannot be kept due to disease or injury. Bladder cancer is a common reason, especially if a person needs a radical cystectomy.

Other causes include damage from radiation, birth defects, or ongoing bladder problems. The surgery may also be considered after severe trauma or if other treatments fail to control urinary incontinence.

Main Reasons	Details
Bladder cancer	After complete bladder removal.
Birth conditions	When repair is not possible.
Nerve disorders	When bladder function is lost.
Injury	From serious accidents.
Other diseases	Such as severe inflammation or infection.

Possible Complications

Neobladder surgery can lead to different risks. These may include bleeding, blood clots, and infections. Some people experience urine leaks or have trouble emptying their bladder. Other issues, such as electrolyte changes, vitamin B-12 deficiency, or incontinence, may also happen. In rare cases, cancer can develop in the bowel. Urinary tract infections, changes in liver function, and problems related to lymph node dissection or longer operative time may occur.

Steps for Preparation

Nutrition and Medication Guidelines

Doctors often ask patients to follow a clear liquid diet for one to two days before surgery. Patients must stop eating and drinking after midnight prior to the procedure.

Patients should share all current medications, vitamins, and supplements with the healthcare team. In some cases, the care team may advise patients to pause certain medicines before the operation.

Do Before Surgery	Why
Follow a clear liquid diet.	Keeps digestive system ready.
Stop eating/drinking at midnight.	Reduces risk during anesthesia.
List all medications and supplements.	Helps avoid drug interactions.
Stop medication if advised.	Lowers risk of complications.

Training for Self-Catheter Use

Some people may have trouble emptying their neobladder after surgery. A health professional teaches patients how to use a thin tube called a catheter to drain urine when needed. Practicing this skill helps prevent urinary retention and pressure on the new bladder.

What You Can Expect

Steps Taken Prior to Surgery

Before neobladder surgery, doctors order tests to check kidney health and make sure there are no current infections. Imaging scans, such as a CT scan, help the care team examine the urinary tract.

This allows the team to confirm that the ureters and surrounding areas are suitable for surgery. Good results depend on having no ongoing infections and properly working kidneys.

The Surgical Process

Surgeons remove the bladder and create a new one from a section of the intestine. The intestine is reshaped into a pouch that functions as a replacement bladder. The surgical team attaches this pouch to the ureters, which carry urine from the kidneys, and also to the urethra.

Main Steps

Step	Description
Bladder Removal	The damaged or diseased bladder is taken out.
Intestinal Preparation	A segment of the intestine is separated and cleaned.
New Bladder Creation	The tissue is formed into a round pouch.
Connections	This pouch is joined to the ureters and urethra.
Intestinal Repair	The remaining intestine is reconnected.
Catheter Placement	A catheter is placed temporarily for drainage.

Surgeons may use traditional open surgery or a laparoscopic approach. Laparoscopic and robot-assisted surgeries often involve smaller cuts. These methods can sometimes help patients recover faster and experience less pain after the procedure.

Recovery and Life Following Surgery

After surgery, patients usually stay in the hospital for three to five days. Before discharge, the care team provides instructions on wound care, catheter management, and a schedule for emptying the new bladder. Patients also learn exercises to strengthen pelvic muscles, which helps improve bladder control.

Regaining full control of urination (continence) may take several months. During the early recovery period, some urine leakage—especially at night—is common. Most people see improvement during the first year, with daytime control typically getting better within 6 to 12 months. Nighttime control can take longer.

Some may continue to have problems with incontinence at night, which can affect quality of life (QoL). Regular follow-up appointments help monitor the neobladder’s function, track recovery, and check for infections. The care team provides long-term support to maintain health and quality of life after surgery.