Neobladder Reconstruction

What is bladder reconstruction surgery?

Neobladder reconstruction surgery is a type of urinary reconstruction and diversion to replace a diseased or nonfunctioning urinary bladder. The procedure creates a new bladder (neobladder) to store and remove urine (pee) from your body.

Healthcare providers first remove your bladder (cystectomy) as part of your treatment plan. Then, they use a piece of your small intestine to create a new bladder (urinary diversion) in the same location as your original bladder. 

Not everyone is a candidate for neobladder reconstruction surgery. Your healthcare team will determine your candidacy according to several factors, including how healthy your liver and kidneys are and whether you have urethral cancer.

Another name for neobladder reconstruction is orthotopic neobladder reconstruction. “Orthotopic” means the neobladder will be in the same position in your body as your original bladder.

Why would you need bladder reconstruction?

A healthcare provider may recommend neobladder reconstruction to treat conditions that affect the health or functionality of your bladder, including:

• Bladder cancer.
• Bladder muscles that can’t contract (squeeze) properly to release pee (decompensated bladder). This can happen after radiation therapy or because of brain or spinal cord conditions (neurogenic bladder).
• Bladder exstrophy.
• Interstitial cystitis/bladder pain syndrome (IC/BPS).
• An injury (trauma) to your bladder.
• Any other severe conditions that affect your bladder.

How should I prepare for neobladder reconstruction surgery?

You’ll meet with a healthcare provider before neobladder reconstruction. They’ll review other urinary diversion options with you and detail the pros and cons of neobladder reconstruction and why they recommend it. They’ll review your medical history and conduct a physical examination to determine your general health. They may also order a urinalysis (urine test) to ensure you don’t have a urinary tract infection (UTI) and noninvasive imaging tests to ensure other parts of your urinary system are healthy.

Your provider will also ask about any prescription or over-the-counter (OTC) medications you’re taking. Certain medications can increase your risk of significant blood loss during surgery, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs).
• Acetaminophen (Tylenol^®).
• Blood thinners (anticoagulants).
• Certain herbal supplements.

Be sure to check with a provider before you stop taking any medications.

You should also tell the provider about all of your known allergies. These include:

• Medications.
• Skin cleaners, like chlorhexidine, iodine or isopropyl alcohol.
• Latex.
• Foods.

You’ll also receive specific directions on eating and drinking before neobladder reconstruction surgery. You shouldn’t eat or drink anything after midnight the night before your surgery. If there are any medications you must take, you should take them with a small sip of water.

What type of healthcare provider performs neobladder reconstruction?

A special team of healthcare providers performs neobladder reconstruction. Your team generally consists of:

• A urologist.
• An anesthesiologist.
• Nurses.

What happens during neobladder reconstruction surgery?

During neobladder reconstruction surgery, your healthcare team will:

• Give you general anesthesia. You’ll be asleep for the procedure and won’t feel any pain.
• Remove your bladder through a large cut (incision) or several smaller cuts (robotic surgery) they make in your abdomen.
• Isolate a part of your small intestine and form it into a ball-like (spherical) shape. This is your neobladder.
• Place your neobladder in the space that your original bladder had previously occupied.
• Attach your ureters and urethra to the neobladder.
• Reattach the sections of your small intestines.
• Possibly insert a surgical drain to help remove blood or fluid from your body.
• Use sutures (stitches), surgical staples or both to close your incision(s).
• Insert a urinary catheter into your urethra to drain pee while you heal.

How long does this neobladder reconstruction surgery take?

Neobladder reconstruction surgery typically takes between two and six hours to complete.

What happens after neobladder reconstruction surgery?

After neobladder reconstruction surgery, your healthcare team will:

• Cover your incisions with bandages.
• Stop putting anesthesia into your body. You’ll be conscious (awake) after a few minutes. But you’ll likely feel groggy.
• Take you to a recovery room.
• Treat your pain.
• Monitor your recovery and overall health.

You need to stay in the hospital for at least a few days after neobladder reconstruction surgery. The length of your hospital stay depends on whether you have a robotic surgery or open surgery. Open surgery requires a longer hospital stay.

As you recover in the hospital, your healthcare team will teach you:

• How to manage your pain. This may include medications, rest and relaxation techniques.
• Pelvic floor exercises (Kegel exercises). Kegel exercises help strengthen your pelvic floor muscles and prevent urinary incontinence. Your pelvic floor muscles squeeze and relax to control when you pee and defecate (poop).

They may also teach you how to self-catheterize. About 15% of people need to self-catheterize after neobladder reconstruction surgery. As your body heals, you must change your urinary catheter on your own to release pee from your bladder.

What are the benefits of neobladder reconstruction surgery?

One of the biggest benefits of neobladder reconstruction surgery is that you can continue to pee through your urethra and control when you pee.

You also don’t need to use a urostomy bag or pouch outside your body to collect your pee. For many, this helps improve their quality of life and preserve a positive self-image.

What is the success rate of bladder reconstruction surgery?

A 2016 study shows:

• More than 90% of people could control when they pee during the day (daytime continence) 12 to 18 months after surgery.
• More than 50% of people no longer involuntarily peed while sleeping (nighttime incontinence or bedwetting) 18 to 36 months after surgery.
• About 10% to 15% of people would need to self-catheterize.

What are the disadvantages of a neobladder?

Risks or complications that may develop after neobladder reconstruction surgery include:

• Bleeding.
• Blood clots.
• Bacterial infection.
• Urinary incontinence.
• Mucus in your pee.
• Kidney stones.
• UTIs.
• Not being able to fully empty your neobladder (urinary retention).
• Blockage (stricture) where your neobladder meets your urethra.

Rarely, you may have an electrolyte imbalance. Electrolytes normally leave your body when you pee. But your neobladder consists of part of your small intestine, and your small intestine absorbs electrolytes. Your neobladder may reabsorb them and cause electrolyte imbalances in your blood.

Your small intestine also creates mucus. You may need to regularly wash out (irrigate) your neobladder with a catheter that you insert through your urethra to prevent infections.

How long does it take to recover from neobladder reconstruction surgery?

It may take several months to recover from a cystectomy and neobladder reconstruction surgery. You may also need some time to adjust to changes in your body, including emptying your bladder, rinsing it out and building up your pelvic floor muscles. Your healthcare providers will work with you to adapt to these changes.

How do you pee with a neobladder?

The neobladder goes into the same space of your body as your original bladder. It connects to your ureters (tubes of muscle that connect your kidneys to your bladder) and urethra (the tube that allows pee to go from your bladder to the outside of your body). So, pee comes out of your body the same way it would with your original, healthy bladder. For most people, once they recover after neobladder reconstruction surgery, they can control when they pee throughout the day.

How often do you have to pee with a neobladder?

Your neobladder won’t be able to hold a lot of pee right after surgery. You’ll likely have to pee at least every two hours. As you heal and your bladder gets stronger and stretches, you should be able to hold your pee for up to six hours before you have to use the restroom.

Can you live a normal life with a neobladder?

Yes, people with a neobladder are usually able to return to their normal activities and work.

• You should be able to return to work or school and resume light physical activities after a few weeks.
• You don’t have to avoid certain foods or drinks. But if you have any dietary concerns, bring them up to a healthcare provider.
• You can travel without any restrictions.

When should I call a healthcare provider?

Contact your healthcare provider right away if you have:

• Signs of infection, including fever, chills or cloudy pee.
• Difficulty performing self-catheterization.
• Blood in your pee (hematuria).
• Pain in your belly or between your ribs and hips (flank).

Providers can answer any other questions or concerns you have. They can also connect you to neobladder support groups.

What is the difference between an ileal conduit and a neobladder?

An ideal conduit is similar to a neobladder, but it isn’t the same. During an ileal conduit procedure, a surgeon creates a tube out of part of your intestine and connects it to your kidneys. Pee continually exits your body through a small opening (stoma) in your belly into a urostomy bag.

A note from Cleveland Clinic

Neobladder reconstruction involves removing your bladder and replacing it with a new one that a surgeon makes from a small part of your intestine. A provider may recommend neobladder reconstruction to treat bladder cancer, decompensated bladder or another condition that affects your bladder. It may take a few months to fully recover, and you’ll likely have to adjust to new habits or routines until your body heals and your neobladder stretches. But a neobladder can increase your overall comfort and well-being. Reach out to a healthcare provider if you have any questions or concerns.