Neobladder Offers Convenient Option for Some
CancerWise - May 2007
By Dawn Dorsey
If the spread of cancer necessitates removing the bladder, surgical procedures known as urinary diversions often can help restore urinary function. An orthotopic neobladder is one type of diversion that allows some patients to avoid an external pouch that stores urine.
A neobladder (new bladder) is a man-made bladder created with tissue from the intestines. Also called an orthotopic reconstruction, this substitute bladder is placed in the same location as the original bladder.
This procedure has a longer history in men, says O. Lenaine Westney, M.D., an associate professor in
M. D. Anderson’s Department of Urology and interim director of the Division of Urology at The University of Texas Medical School at Houston.
“It provides good daytime urinary control, with about 10% chance of incontinence during the day,” Westney says. “However, there is about 20% chance of incontinence at night.”
Neobladder differs in inability to contract
The neobladder is made to function like a normal bladder, Westney says. Surgeons connect the neobladder to the ureters (kidney tubes) and urethra (tube that carries urine from the bladder to the outside of the body). Urine drains from the kidneys through the ureters into the neobladder, then through the urethra.
However, the neobladder does not work exactly like a regular bladder.
A normal bladder:
- Expands to hold urine
- Contracts to pass urine
A neobladder can expand, but it is not able to tighten or contract, so patients must learn to control their muscles so they can pass urine.
Surgeons create new bladder from intestines
Urinary diversions are performed at the same time as a cystectomy (surgical removal of the bladder).
In a neobladder procedure, the surgeon:
- Removes part of the intestine
- Dissects a piece of intestine that was removed
- Flattens the piece of intestine
- Makes a pouch by suturing the piece together
- Joins the ureters to one end of the pouch
- Connects the urethra to the other end of the pouch
It is a complex procedure that requires several weeks of hospitalization and healing time.
Even if a patient is willing to commit to the procedure, not every patient is a candidate for a neobladder.
Some patients ineligible for a neobladder have had:
- Radiation therapy to the pelvis
- Bowel abnormalities
- Removal of the urinary sphincter muscle
Other patients might be ineligible based on:
- Kidney function
- Pre-operative incontinence
- Pelvic radiation history
- Primary tumor type
- Manual dexterity
Manual dexterity is important because patients need to use a catheter, a hollow tube for draining urine.
Recovery requires patience, practice
After surgery, a catheter is inserted in the neobladder. It remains there for about a month and then is removed in the hospital.
“After the catheter is removed, patients need to use a pad to absorb urine, at first,” Westney says. “Patients then need to build pelvic strength with Kegel exercises (a series of controlled muscle contractions at the base of the pelvis).”
To pass urine, many patients must relax the pelvic muscles and contract the abdominal muscles. This puts pressure on the neobladder and forces urine from the body.
At first, patients need to empty the bladder every one to three hours. The capacity of the new bladder will increase over time. After three to six months, it should hold around a pint of urine, similar to a normal bladder.
Certain people may need to use a small disposable catheter several times a day to completely empty the neobladder.
Procedure has advantages, disadvantages
The major advantages of the neobladder are that it does not require an external collection pouch to store urine or an abdominal stoma, a surgical opening on the outside of the body through which urine passes. A few months after surgery, most patients can empty the neobladder by urinating.
The main complication of the neobladder, Westney says, is that kidney stones occur in about 10% of cases. To prevent stones, patients use a catheter to irrigate the neobladder on a daily to weekly basis.
Another problem for some people is leakage of urine. This is especially prevalent at night, as the involuntary muscles of the sphincter relax during sleep. The problem usually improves over time, but it may continue for several months.
Following neobladder surgery, some people also notice a change in bowel habits, such as frequency or consistency of bowel movements. This is because the bowel was shortened to construct the new bladder.
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