What is Neobladder Reconstruction? Purpose, Procedure & Recovery

Neobladder reconstruction is a surgical procedure that creates a new bladder from a section of your intestine when your original bladder needs to be removed. This remarkable surgery gives you the ability to urinate normally again, often allowing you to maintain control and dignity after bladder removal due to cancer or other serious conditions.

Think of it as your surgeon's way of giving you back something close to what you had before. While it's a major surgery, thousands of people have successfully undergone this procedure and returned to fulfilling, active lives.

What is neobladder reconstruction?

Neobladder reconstruction involves using a portion of your small intestine to create a new bladder that connects directly to your urethra. Your surgeon carefully reshapes this intestinal tissue into a pouch that can store urine and allow you to urinate through your natural opening.

This procedure is also called an orthotopic neobladder, which simply means the new bladder sits in the same place as your original one. The goal is to restore as normal a urinary function as possible after your bladder has been removed.

Your new bladder won't work exactly like your original one, but many people find they can urinate normally during the day and achieve good control over time. The intestinal tissue adapts to its new role, though it may take several months for everything to settle into a comfortable routine.

Why is neobladder reconstruction done?

This surgery is most commonly performed after a radical cystectomy, which is the complete removal of your bladder due to bladder cancer. When cancer has spread into the muscle wall of your bladder, removing the entire organ often provides the best chance for a cure.

Your doctor might also recommend this procedure for other serious conditions that require bladder removal. These can include severe radiation damage to the bladder, certain birth defects, or extensive trauma that has damaged the bladder beyond repair.

The decision to proceed with neobladder reconstruction depends on several factors about your health and anatomy. Your surgeon will carefully evaluate whether you're a good candidate based on your kidney function, the condition of your urethra, and your overall health status.

What is the procedure for neobladder reconstruction?

The surgery typically takes 4 to 6 hours and is performed under general anesthesia. Your surgeon will make an incision in your abdomen to access your bladder and surrounding organs, then carefully remove your bladder while preserving important nearby structures.

Here's what happens during the main steps of the procedure:

1. Your surgeon removes about 24 inches of your small intestine, usually from the ileum section
2. The remaining intestine is reconnected so your digestive system continues to work normally
3. The removed intestinal segment is carefully reshaped into a spherical pouch
4. This new bladder is connected to your ureters (the tubes from your kidneys)
5. The pouch is then attached to your urethra, allowing you to urinate naturally

Your surgeon may also place temporary tubes called stents in your ureters to help healing, along with a catheter to drain urine while your new bladder heals. These are typically removed after a few weeks once everything is working properly.

How to prepare for your neobladder reconstruction?

Preparation for this surgery involves several important steps to ensure the best possible outcome. Your medical team will guide you through each requirement, but planning ahead helps reduce stress and supports your recovery.

Your doctor will likely ask you to complete these preparatory steps:

• Stop smoking at least 2 weeks before surgery to improve healing
• Complete bowel preparation with special cleansing solutions 1-2 days before
• Arrange for someone to drive you home and stay with you for the first few days
• Remove nail polish and jewelry before arriving at the hospital
• Take prescribed antibiotics to prevent infection
• Follow fasting instructions, typically no food or drink after midnight before surgery

Your healthcare team will also review your medications and may ask you to stop certain blood thinners or supplements. Don't hesitate to ask questions about anything you don't understand - this is a big step, and feeling informed helps many people feel more confident.

How to read your neobladder function tests?

After your surgery, your medical team will monitor how well your new bladder is working through various tests and observations. Understanding these measurements can help you track your progress and know what to expect during recovery.

Your doctors will typically evaluate several key indicators:

• Urine output volume - should gradually increase to 1-2 liters per day
• Residual urine after urination - ideally less than 100ml remaining
• Creatinine levels - should stay stable, indicating good kidney function
• Electrolyte balance - particularly chloride levels, which can be affected
• Continence rates - ability to hold urine during day and night

Normal recovery usually shows steady improvement in these areas over 3-6 months. Your new bladder capacity will gradually increase, and your control will improve as the tissues adapt and you learn new techniques for emptying completely.

How to optimize your neobladder function?

Living successfully with a neobladder requires learning some new habits and techniques. The good news is that most people adapt well and can return to their normal activities with some adjustments.

These strategies can help you achieve the best possible function:

• Practice timed voiding every 2-3 hours during the day
• Learn proper emptying techniques, including relaxing and taking your time
• Perform pelvic floor exercises to strengthen supporting muscles
• Stay well-hydrated with 6-8 glasses of water daily
• Avoid bladder irritants like caffeine, alcohol, and spicy foods initially
• Use the Valsalva maneuver (gentle pushing) to help empty completely

Many people find that waking up once or twice during the night to urinate prevents accidents and keeps their new bladder healthy. This becomes easier with practice, and most people develop a routine that works well for their lifestyle.

What are the risk factors for neobladder complications?

While neobladder reconstruction is generally successful, certain factors can increase the risk of complications or affect how well your new bladder works. Understanding these helps you and your doctor make the best decisions for your care.

Several factors may influence your surgical outcome:

• Advanced age (over 70) may affect healing and continence rates
• Previous radiation therapy to the pelvis can impact tissue healing
• Kidney function problems may affect your eligibility for this procedure
• Inflammatory bowel disease can complicate using intestinal tissue
• Smoking significantly increases infection and healing complications
• Diabetes may slow healing and increase infection risk

Your surgical team will carefully evaluate these factors before recommending neobladder reconstruction. Sometimes alternative procedures might be more appropriate based on your individual situation, and that's perfectly okay.

Is neobladder reconstruction better than other options?

Neobladder reconstruction offers the significant advantage of allowing you to urinate normally through your natural opening, which many people find psychologically and practically important. However, it's not necessarily the best choice for everyone.

Compared to other bladder replacement options, a neobladder typically provides better quality of life for people who are good candidates. You won't need to manage an external pouch or perform catheterization through an opening in your abdomen.

However, other procedures like ileal conduit or continent cutaneous diversion might be better choices if you have certain health conditions or anatomy that makes neobladder reconstruction more risky. Your surgeon will help you understand which option offers the best balance of safety and function for your specific situation.

What are the possible complications of neobladder reconstruction?

Like any major surgery, neobladder reconstruction carries some risks that you should understand before making your decision. Most complications are manageable, and serious problems are relatively uncommon with experienced surgical teams.

Common complications that may occur include:

• Urinary incontinence, especially at night, affecting 10-30% of patients
• Incomplete emptying requiring occasional catheterization
• Urinary tract infections, which may be more frequent initially
• Metabolic changes due to urine contact with intestinal tissue
• Strictures or narrowing at connection points
• Kidney problems if urine backs up into the ureters

Less common but more serious complications can include blood clots, severe infections, or problems with wound healing. Your surgical team will monitor you closely and address any issues promptly if they arise.

Rare complications might involve major bleeding, bowel obstruction, or significant metabolic disorders. While these sound concerning, they occur in less than 5% of cases and are usually manageable with proper medical care.

When should I see a doctor about neobladder concerns?

After your neobladder reconstruction, it's important to stay in close contact with your medical team and know when to seek additional help. Most issues can be resolved quickly when addressed early.

Contact your doctor promptly if you experience:

• Fever over 101°F (38.3°C) or chills
• Severe abdominal pain or swelling
• Complete inability to urinate or severe burning
• Blood in urine that's more than light pink
• Nausea and vomiting that prevents eating or drinking
• Signs of dehydration like dizziness or dry mouth

You should also reach out if you notice sudden changes in your urination pattern, persistent leaking that's getting worse rather than better, or any symptoms that worry you. Your healthcare team expects these calls and would rather address small problems before they become bigger ones.