Sometimes, due to cancer or other serious medical conditions, a person's entire bladder has to be removed. Many people are afraid, "How will I urinate now?" But fear not, with the advancement of medical science, there is a good solution for this. That is, using a part of your own intestine, a brand new bladder is created inside the body. Today, we are talking about this amazing surgery, which is called Neobladder surgery.
What is 'Neobladder' surgery simply?
Simply put, this is a surgery to create a new bladder to replace your diseased, dysfunctional bladder. In this, doctors first remove your original bladder through surgery. This is called a cystectomy . Then, they take a small piece of your own small intestine and use it to create a new bladder (neobladder) that is shaped like a ball.
This new bladder is placed in the same place as your old bladder. That's why it's sometimes called an 'orthotopic' neobladder. 'Orthotopic' means "in the same place." This is what we call a neobladder reconstruction, which creates a new system to store and excrete urine.
But this surgery is not for everyone. Doctors will decide whether you are suitable for this based on several factors, such as how healthy your kidneys and liver are and whether you have bladder cancer.
In what cases is this surgery necessary?
A doctor may recommend this surgery for a variety of conditions that affect the health or function of your bladder. Let's take a look at what they are.
| Medical condition | A simple explanation |
|---|---|
| Bladder cancer | The main reason for having the bladder removed. |
| Weakened bladder muscles (Decompensated bladder) | The bladder muscles do not contract as needed to empty the bladder. This condition can occur after radiation therapy or due to diseases of the nervous system. |
| Neurogenic bladder | Loss of bladder control due to diseases of the brain or spinal cord. |
| Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) | A chronic painful condition in the bladder. |
| Trauma to the bladder | Bladder damage due to a serious accident. |
How do you prepare before surgery?
Before the surgery, you will meet with a urologist. He will explain the pros and cons of the surgery, as well as other options, and will review your medical history and perform a physical exam to assess your overall health.
In addition, you will be asked about these things:
- Medications you take: You should tell your doctor about any medications you are taking (both prescription and over-the-counter). Some pain relievers (NSAIDs) and blood thinners (anticoagulants) can increase the risk of bleeding during surgery. But remember, don't stop taking any medication without first asking your doctor.
- Your Allergies: Be sure to tell us about any allergies you have to medications, skin cleansers (like iodine), latex, or foods.
- Food and Drink: You will be advised not to eat or drink anything after midnight the night before the surgery. If you have any essential medication, you can take it with a sip of water.
How the surgery is performed step by step
This is a major surgery that takes about two to six hours. Let's take a step-by-step look at what happens during this.
| Steps | What is happening? |
|---|---|
| 1. Anesthesia | You will be put to sleep (general anesthesia), so you will not feel any pain. |
| 2. Bladder removal | Your old bladder will be removed through a large incision in your abdomen (open surgery) or several small incisions (robotic surgery). |
| 3. Creating the Neobladder | A section of your small intestine is removed and shaped into a ball. This is your new bladder. |
| 4. Reconnecting | The new bladder is placed in the same place as the old one, and the tubes from the kidneys (ureters) and the tube that carries urine (urethra) are connected to it. |
| 5. Closure of incisions and placement of tubes | The incisions will be closed with stitches or surgical staples. A urinary catheter will be placed in your urethra to drain urine until it heals. |
What happens after the surgery? How long will it take to recover?
After the surgery, you will need to stay in the hospital for a few days. You will feel a little tired after you regain consciousness. At the hospital, the medical team will give you medication to control your pain and monitor your health.
During recovery, you will be taught about:
- Pelvic floor exercises (Kegel exercises): This is very important. These exercises strengthen the muscles that control your bladder. Therefore, this helps a lot in preventing urinary incontinence.
- Self-catheterization: Not everyone needs it, but about 15% of people will need to use this method to completely empty their bladder at first. Don't worry, we'll show you exactly how to do it.
It can take several months to fully recover. It takes time to get used to your new bladder, learn how to empty it, and strengthen your muscles. Your doctor and nursing staff will help you with all of this.
What are the advantages and disadvantages of a Neobladder?
The biggest advantage of this surgery is that you can urinate normally through your urethra, without having to use a urostomy bag. This improves the quality of life and self-confidence of many people.
But like everything, there are some risks and disadvantages to this.
- Bladder control: It can be difficult to control your bladder at first, especially at night. However, over time, especially with Kegel exercises, about 90% of people will have good control during the day.
- Mucus in the urine: Since the new bladder is made from a section of the intestine, it produces a mucus-like secretion. Therefore, to prevent infection, it is sometimes necessary to insert a catheter and irrigate the bladder.
- Other risks: Bleeding, blood clots, bacterial infections, urinary tract infections (UTIs), urinary retention, etc. Rarely, electrolyte imbalances may occur.
Is it possible to live a normal life with a neobladder?
Yes, absolutely! The majority of people with a neobladder can continue their normal activities and jobs.
At first, you will need to urinate about every two hours. But over time, as your new bladder stretches and becomes stronger, you will be able to hold your urine for about 4-6 hours. In a few weeks, you will be able to do light work and go to work. There are no special food restrictions, and you can travel without any restrictions.
Occasions when you want to see a doctor
If you have these symptoms, call your doctor immediately. If the symptoms are severe, go to the Emergency Department (ETU) of the nearest hospital.
- Signs of infection such as fever, chills, and cloudy urine.
- It is difficult to insert the catheter alone.
- Blood in the urine (hematuria) .
- Severe pain in the stomach or between the ribs and hips.
Take-Home Message
- Neobladder surgery is the best way to live a normal life without a bag outside the body after removing the bladder.
- This new bladder is made using part of your own small intestine.
- It will take several months to heal. During this time, it is very important to be patient and follow the doctor's instructions, especially Kegel exercises.
- Although there may be some difficulty with urinary control at first, over time, most people are able to lead normal, active lives.
- If you have any questions or doubts, don't be afraid to talk openly with your doctor about it.
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