Neobladder Reconstruction

Neobladder reconstruction, also known as orthotopic neobladder reconstruction, is a surgical procedure that involves creating a new bladder from a segment of intestine after the removal of the original bladder due to disease or injury.

Indications

The primary indication for neobladder reconstruction is the treatment of bladder cancer, where the entire bladder needs to be removed (cystectomy). Other indications may include:

• Severe bladder dysfunction due to neurogenic bladder or other conditions
• Bladder damage from injury or infection
• Congenital abnormalities of the bladder

Surgical Procedure

The neobladder reconstruction procedure typically involves the following steps:

1. Cystectomy: The original bladder is removed, along with any affected surrounding tissues or organs.
2. Harvesting of intestinal segment: A segment of intestine (usually from the ileum or sigmoid colon) is selected and isolated to be used as the new bladder.
3. Creation of the neobladder: The isolated intestinal segment is folded and shaped into a spherical or oval configuration, and the edges are sewn together to create the new bladder.
4. Ureteral anastomosis: The ureters (tubes that carry urine from the kidneys to the bladder) are connected to the neobladder.
5. Urethral anastomosis: The neobladder is connected to the urethra, allowing for normal urination.

Types of Neobladders

There are several types of neobladders that can be constructed, including:

• Studer pouch: A type of neobladder that uses a segment of ileum and is shaped like a sphere.
• Hemi-Kock pouch: A type of neobladder that uses a segment of colon and is shaped like a hemisphere.
• T-pouch: A type of neobladder that uses a segment of ileum and is shaped like a T.

Postoperative Care and Complications

After the surgery, patients typically require:

• Urinary catheterization for several weeks to allow the neobladder to heal
• Avoidance of heavy lifting, bending, or strenuous activities for several months
• Follow-up appointments with their healthcare provider to monitor for complications and adjust medications as needed

Possible complications of neobladder reconstruction include:

• Urinary incontinence
• Urinary tract infections
• Bladder stones
• Metabolic disorders (e.g., vitamin B12 deficiency)

Outcomes and Quality of Life

The success of neobladder reconstruction depends on various factors, including the patient's overall health, the type of neobladder constructed, and the presence of any complications. Many patients are able to achieve good urinary function and quality of life after the procedure.