neobladder

A neobladder is a surgically created urinary reservoir designed to replace the urinary bladder after cystectomy, typically for muscle-invasive bladder cancer. It uses a segment of the intestine (most often ileum) to form a detubularized reservoir that stores urine, with the goal of allowing urinary continence and voiding through the natural urethra in an orthotopic configuration.

Construction and types: The most common approach uses detubularized ileal segments fashioned into a spherical or pouch-like reservoir. Ureters are reimplanted into the reservoir, and a continence mechanism (such as a nipple valve or intussuscepted segment) helps prevent leakage. When the neobladder is connected to the urethra, it is called an orthotopic neobladder; alternative reservoirs may be designed with catheterizable channels or stomas. Widely used designs include the Studer and Hautmann pouches, which differ in segment length and configuration but share the detubularization principle.

Function and outcomes: An orthotopic neobladder aims to preserve body image and enable spontaneous voiding. Typical capacity ranges from several hundred milliliters, with varying continence rates. Some patients retain voluntary control, while others require intermittent self-catheterization for residual urine. Long-term outcomes depend on patient selection, surgical technique, and adherence to follow-up care.

Complications and follow-up: Potential issues include metabolic disturbances (hyperchloremic metabolic acidosis from intestinal mucosa), mucus production, stone formation, anastomotic or urethral strictures, and reservoir dilation or obstruction. Regular follow-up involves monitoring renal function, metabolic status, urodynamics, imaging, and management of bowel or electrolyte changes. With appropriate care, many patients achieve good functional results and quality of life after neobladder reconstruction.