Orthotopic Neobladder Reconstruction

Orthotopic neobladder reconstruction is a surgical procedure used to create a new bladder, known as a neobladder, after the removal of the original bladder due to disease or injury. This procedure is typically performed on patients who have undergone a cystectomy, which is the surgical removal of the bladder.

Indications

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

• Severe bladder dysfunction due to neurological disorders or other conditions
• Bladder damage due to injury or trauma
• Congenital abnormalities of the bladder

Surgical Technique

The procedure involves several steps:

1. Cystectomy: The original bladder is removed, along with any surrounding tissue that may be affected by disease.
2. Harvesting of intestinal segment: A portion of the intestine (usually the ileum or sigmoid colon) is removed and used to create the new bladder.
3. Creation of the neobladder: The harvested intestinal segment is folded and shaped into a sphere, and the edges are sewn together to form the new bladder.
4. Anastomosis: The ureters (tubes that carry urine from the kidneys to the bladder) are connected to the neobladder, and the urethra (tube that carries urine out of the body) is also connected to the neobladder.

Types of Neobladders

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

• Studer pouch: A type of neobladder that uses a portion of the ileum to create a spherical bladder.
• Hautmann pouch: A type of neobladder that uses a portion of the ileum to create a spherical bladder with a more complex configuration.
• Padua pouch: A type of neobladder that uses a portion of the sigmoid colon to create a spherical bladder.

Postoperative Care and Complications

After the procedure, patients typically require:

• Several days of hospitalization for monitoring and recovery
• A urinary catheter to drain urine from the neobladder
• Antibiotics to prevent infection
• Pain management medication to control discomfort

Possible complications of orthotopic neobladder reconstruction include:

• Urinary leakage or fistula formation
• Infection or sepsis
• Bowel obstruction or adhesions
• Metabolic disturbances due to the use of intestinal tissue for the neobladder

Long-term Outcomes and Quality of Life

Most patients who undergo orthotopic neobladder reconstruction are able to achieve good urinary function and quality of life. However, some patients may experience:

• Urinary incontinence or leakage
• Nocturia (waking up at night to urinate)
• Decreased bladder capacity or compliance
• Changes in bowel habits due to the use of intestinal tissue for the neobladder

Regular follow-up with a healthcare provider is essential to monitor the function of the neobladder and address any potential complications or concerns.