Neobladder: What Is It and Why Someone Might Need a Neobladder

It is important to remember to talk to a trained urologist, as each case should be evaluated on a case-by-case basis; however, the top reasons why someone might need a neobladder includes bladder cancer. If someone has bladder cancer, they may need to have some or all of the bladder removed as part of the treatment process.

If you have questions about whether you might benefit from one, reach out to a medical professional who can assist you.

This is an image of a neobladder.

What is a Neobladder?

A neobladder is a type or urinary diversion available following a radical cystectomy. If you have a radical cystectomy, it allows you to store urine in your body. You continue to pass urine through your urethra. removing it requires surgery. In this surgery, a part of the small intestine is reshaped to create a new bladder, allowing urine to be stored and then passed in the usual way through the urethra. This type of surgery is complex and lengthy, requiring the patient to be in good health. It’s different from other urinary diversions, like the ileal conduit, because it aims for a more natural urine passage.

After surgery, patients may have a catheter for about three weeks to help the new bladder heal. The recovery process varies, with some needing to learn how to control urination again. The neobladder’s capacity is ideally around 500-600 cc, but it can be trained to hold more. Nighttime urination and the risk of urinary tract infections are concerns, with lifestyle adjustments and hydration being important for maintenance. Despite the challenges, many find a significant improvement in quality of life with a neobladder, adapting to this new normal without major lifestyle restrictions.

How Is a Neobladder Created?

Normally, urine passes from the kidneys through the ureters and into the bladder. From the bladder, urine moves through the urethra and out of the body. After removing the bladder, a segment of the small intestine is used to form a new (neo) pouch for urine.

This neobladder is attached to the ureters and the urethra, so urine passes through it like a normal bladder. By tensing the abdominal muscles and relaxing certain muscles, the patient can push the urine through the urethra. Some patients will be able to hold urine in their neobladder, but they may need to use a catheter to help remove the urine from their body.
Other patients are not able to have a neobladder because of the extent of their bladder tumor, decreased renal (kidney) function, their general health, or because of other treatments they have had in the past.

The Risks of Having a Neobladder Placed

A neobladder is placed as part of a reconstructive procedure, so there are a few risks involved, including:

  • Whenever the surface of the skin is broken, there is a chance that an infection could develop.
  • During a surgical procedure, bleeding or blood clots could develop.
  • There is also a chance of urinary leakage or urinary retention following the placement of it.
  • Certain electrolyte imbalances may develop as a result of having it placed.
  • Vitamin B12 deficiency could develop after it is placed.
  • Sometimes, there can be a loss of bladder control following the procedure, which is called incontinence.

A neobladder is placed by a trained surgical professional. When all best practices are followed, the chances of complications and side effects developing are minimal. If you have questions about the risks, you should talk to a urologist who can assist you.

Preparing for Neobladder Surgery

Ask your doctor about any special preparations you should follow before your surgery. These can include:

  • Any medication or herbal use you should avoid or stop taking
  • Food and drink limitations

What to Expect After Neobladder Surgery

Getting used to the neobladder will take time and patience.

  • Emptying your new bladder will not work in the same way as a normal bladder.
  • You must train your muscles to put pressure on the neobladder to force urine out.
  • You will be shown how to perform pelvic floor exercises to strengthen those muscles.
  • If you cannot urinate after the surgery, you might need to use a catheter to empty your bladder.The new bladder will start out small. As it is used, it will expand to hold more urine.

The Top Benefits of a Neobladder

There are several significant advantages of having one placed, including:

  • No need for a stoma: Depending on the exact medical condition, it can eliminate the need for a stoma or an external collection device. People no longer have to worry about collecting urine in a bag and then emptying it later.
  • Store urine normally: After it has been placed, patients should be able to store a normal volume of urine until it is a socially acceptable time for them to void their bladder.
  • Lower infection and bleeding risk: Because the neobladder is placed on the inside, it reduces the chances of bleeding and infection that can be associated with a stoma.
  • Urinate by choice: Having one, patients are once again in control. They decide when they use the bathroom.

These are a few of the biggest advantages of having a neobladder placed. Patients with questions about how they can benefit from a neobladder should talk to a medical professional.

Frequently Asked Questions About a Neobladder

Some of the most common questions people ask about a neobladder include:

Is it possible for a neobladder to develop cancer?

There is a small risk of a neobladder developing cancer. Many are made using living intestinal tissue. Therefore, it is possible for intestinal cancer to develop in the new bladder.

How long does it last?

Every case is different, but it is not unusual for it to last more than 10 years. If you have questions about how long your specific neobladder should last, you should talk to your doctor to learn more.

Can I urinate normally after having it placed?

In the vast majority of cases, someone with a neobladder is able to urinate normally. There is a small chance that you might need a catheter from time to time, but this is highly unusual. The biggest benefit is that you no longer need a pouch outside of your body to collect urine.

Do I need to empty my neobladder in the middle of the night?

It depends on how much liquid you consume and how big it is. There is a chance you may need to do so, but your surgeon can talk to you more about this.

Michael’s feedback on taking care of his neobladder:

How do you take care of your neobladder?

Michael: In my case, none. I do stay well hydrated. I almost never go a day without having at least 80 oz of fluid intake, primarily water and iced tea. One complication of continent diversions (neobladders and internal continent reservoirs such as the Indiana pouch) is metabolic acidosis. This is a potential problem due to the natural movement of water and electrolytes between the inside of the reservoir and the surrounding tissues and blood stream. Good hydration lessens the risk of acidosis as well as lowering the risk of stones. I also try to be quite vigilant through frequent urination about not over-distending the neobladder. Some people with neobladders have a continuing need to self catheterize, usually because of hypercontinence.

Are there any restrictions in lifestyle?

Michael: None. The external appearance is normal except for the scar from the surgery. My surgeon has placed no restrictions on my activity and I currently live an active lifestyle with travel, bicycling (approximately 60-100 miles per week), and weight training. As with all diversions, there is an adjustment period to your new normal.

Learn More About Living with a Neobladder