Neo-Bladder Reconstruction

Neo-bladder reconstruction also known as orthotropic reconstruction is a procedure done in which a new bladder is reconstructed from the bowel tissue, which is usually in contact with the urinary system.

The neo-bladder is generally connected to the urethra, the water pipe and hence, the urine is passed in a natural and normal manner. There are conditions where some patients may require using a catheter (a small and disposable tube) once or twice a day in order to empty the neobladder.

This procedure is usually recommended to the patient who needs to have cystectomy i.e. removal of the bladder. The procedure is not always suitable for every patient who has gone through the cystectomy, for instance, if the patient has undergone radiotherapy for pelvic or has bowel abnormalities, the neo-bladder is not recommended.

The main reason for neo-bladder reconstruction is usually the aim of collecting urine in an internal reservoir in the patients whose bladder has been removed by cystectomy for the treatment of bladder cancer.

Although neo-bladder reconstruction is a potential treatment alternative to passing urine in a possible normal manner, there exist some risks like any other surgical procedure.

Some of the risks associated with neo-bladder reconstruction may include:

• Increased risk of infection
• Bleeding from the wound
• Blood clots in the legs or the lungs
• Irregularities in the heart because of the anesthetic treatment
• Poor wound healing
• Risk of injury to the nearby nerves or tissues

In preparing for the neo-bladder reconstruction the doctor will ask the patient to sign an agreement which will consist of the following points:

Consent: This particular section will include that the patient is well aware of the reason the operation and that the doctor has well explained the information related to the operation.

The benefits related to the operation: This section will contain details about the benefits of the procedure. The benefit may include that after the procedure the person will not require using an external bag to collect the urine.

The risks associated: The section of the agreement will contain the full fledged information about the risks associated with the procedure.

If the patient is a smoker, it is advised that he/she must quit smoking as it may reduce the chances of the success of the operation and may increase the chances of other serious complications.

Here you can find out what to expect from your neo-bladder reconstruction. The procedure of a neo-bladder reconstruction involves the removal of the prostate gland in men whereas, in the case of females the uterus and a cuff of the vagina is removed.

If the woman undergoing the operation has not gone through menopause, then the ovaries are left in place in order to attain normal hormonal balance. There are many ways by which neo-bladder reconstruction is carried out and these methods are mainly named after the surgeons who have developed them.

In general, the procedure involves the use of a small section of the bowel around 45 to 60cm in length, which is further used to reconstruct a new reservoir that will take the place of the previously existing bladder with time.

The tubes are placed into the new reservoir, which mimics urethra. Finally, a catheter is placed inside the new bladder from urethra for around 3-4 weeks. It usually takes 3-4 weeks for the healing process.

The results of neo-bladder reconstruction mainly include permanent changes in the body of the patient post-surgery and the changes made will usually affect the urinary, sexual and reproductive functioning and may also affect the bowel function to some extent.

Passing urine: Post procedure the kidney will produce urine in the normal manner and the produced urine will be collected in the new bladder until the patient decides to empty it. The sensation made for emptying the bladder is different from the usual sensation.

Some people feel a full sensation in the abdomen and some say they have the feel of a wind. The bladder can be emptied at regular interval by monitoring the time. The new bladder’s capacity will increase with time and after 3-6 months it will hold the urine like the original bladder.

Initially, the patients are advised to empty the bladder 2-3 times during the night but with time, the holding capacity of the balder will also increase and the patient will not need to empty it so frequently.

Fertility and sexual function: The procedure will involve the removal of the other tissues or organs which may affect the sexual functioning. In the case of men, the prostate gland is removed and the nerves that are mainly responsible for the erection may also be removed.

But in some cases, these nerves can be preserved which would increase the chances to regain the potency i.e. the ability to get an erection by taking certain medications. As the consequences of the surgery, even if the men regain orgasmic function, he will not be able to ejaculate and therefore, the semen will not be passed into the female.

In the case of women, there is a part of bladder and vagina that shares a blood supply. Thus, the front wall of the vagina has to be removed along with the uterus which leads to the shortening of the vagina and the intercourse may not be possible. The patient is advised to wait for a certain period of time to have intercourse and that too with the use lubricants.

Bowel function: The changes will make the patient use toilet more frequently and the patient may notice that he/she is looser than before which may be due to the shortening of the bowel when the section is removed to reconstruct the bladder.