An orthotopic neobladder is a type of urinary diversion procedure. It’s done after you’ve had your bladder surgically removed.

An orthotopic neobladder is a new, or neo, bladder created from tissue taken from your intestines. It’s placed in the area of your pelvis where your bladder would usually be.

The neobladder is connected to your ureters, the two tubes that transport urine from the kidneys to the bladder. It’s also connected to your urethra, which allows urine to exit the body.

Like a bladder, the neobladder gradually fills with urine. You can then empty the neobladder through your urethra, although some people may need to use a catheter to help them do so.

Getting an orthotopic neobladder is a form of continent urinary diversion. Urinary diversion is a procedure that creates a new way for urine to leave your body. Continent urinary diversion means urine is stored in your body until it can be voided.

An orthotopic neobladder is a urinary diversion option for people who have had their bladder removed through a procedure called a cystectomy.

Cystectomy is one of the main treatments for muscle-invasive bladder cancer. As such, many people receiving a neobladder are receiving treatment for bladder cancer.

Other reasons the bladder may be removed, resulting in the need for urinary diversion such as an orthotopic neobladder, include:

Cystectomy and neobladder creation are done under general anesthesia. That means you will be asleep during the surgery.

After the surgeon removes your bladder, they use a part of your intestine to construct the neobladder. A section of the ileum, which is located at the end of your small intestine, is most often used.

Surgeons typically remove about 55 centimeters (roughly 22 inches) of intestinal tissue. Your intestines are joined back together so they may function as normal.

The surgeon joins your ureters to the top of the neobladder. They then attach the neobladder to your urethra.

Generally speaking, a straightforward procedure can take 2–3 hours. However, more complicated ones can last for 5 hours or longer.

Before your surgery, your healthcare team will order a variety of tests. These tests aim to ensure you are healthy enough for the procedure.

Tests may include:

Your healthcare team will also advise you on things like:

  • when to stop consuming foods and liquids
  • which medications or supplements to temporarily adjust or stop taking
  • how long before your procedure to stop smoking
  • what to bring with you to the hospital on the day of your surgery

Immediately after your surgery, you’re taken to a recovery room. Here, hospital staff monitor your vital signs as you come out of general anesthesia.

When you wake up, you will notice that you have several tubes attached to you, such as:

  • a catheter to drain urine from your neobladder as you heal
  • stents to keep your ureters open
  • wound drainage tubes
  • an intravenous (IV) drip to provide you with fluids or medications

Hospital staff gradually remove these tubes during your initial recovery period. You can expect to stay in the hospital for about 10 days after your surgery.

When you’re ready to go home, your care team will give you instructions, such as:

  • when you can return to various activities
  • how to flush out mucus or debris from your neobladder
  • how to care for surgical wounds and catheters
  • how much liquids to consume each day

Generally speaking, it’s typically advised to avoid strenuous activities or lifting heavy objects for 4–6 weeks after your surgery.

A few weeks after your surgery, you will return to the hospital to have your catheter removed. This allows urine to fill the neobladder and now be passed through the urethra.

During this time, you may need to stay in the hospital for a few days to ensure your neobladder is working properly.

It takes time to adjust to your neobladder.

When you can empty it on your own, you can do so by tightening your abdominal muscles, allowing the urine to pass through your urethra. It’s typically easier to do this sitting down.

At first, you may need to empty your neobladder every 2–3 hours. Over time, your neobladder will stretch, and you can go for longer periods, about 4–6 hours. It’s important not to let your neobladder get too full or it could burst.

Some people can have difficulty completely emptying their neobladder. In this situation, you will use a catheter. Up to 50% of females and 10% of males need to use self-catheterization to empty their neobladder.

It’s also common to leak urine, especially in the months after your surgery. Urine leakage may also be more common at night. Pelvic floor exercises can help strengthen your pelvic muscles and reduce leaking.

Urine leakage often improves over time. For example, a 2018 study found that 65% of people experienced significant daytime leakage 3 months after surgery. This decreased to 8.6% by 12 months.

A 2019 review of research notes that some studies have found people with neobladders had improved quality of life compared with people who had other types of urinary diversion.

However, review authors also note that other studies have not found a significant difference.

Researchers estimate more than half of people getting an orthotopic neobladder will have some type of complication within 90 days of their surgery. Complications mostly affect the urinary or digestive tract.

Some of the risks and complications associated with getting an orthotopic neobladder include:

Your doctor will go over the potential risks and complications associated with having a neobladder. They will also let you know the signs and symptoms of complications and when to seek emergency care.

Does an orthotopic neobladder need to be replaced?

An orthotopic neobladder is not replaced. However, it may need to be repaired if it has become damaged.

Are there people who shouldn’t get an orthotopic neobladder?

Some people may not be eligible to receive an orthotopic neobladder. Examples include people with:

Some people with a neobladder need to manually empty their neobladder using a catheter. As such, it’s important that people receiving a neobladder have the physical and mental ability as well as the willingness to self-catheterize.

Are there alternatives to an orthotopic neobladder?

Yes. There are several other types of urinary diversion. A couple of examples include an ileal conduit and continent cutaneous urinary diversion.

An orthotopic neobladder is a new bladder pouch created using a portion of your intestine. You get an orthotopic neobladder after your bladder has been surgically removed.

People who get an orthotopic neobladder are often receiving treatment for bladder cancer. However, individuals with other conditions may also receive one.

When you have an orthotopic neobladder, you can pass urine out of your urethra, although sometimes you may need to use a catheter to help. Leaking of urine is also common, although this improves over time.