Orthotopic neobladder reconstruction

Abstract

Orthotopic neobladder reconstruction is becoming an increasingly common urinary diversion following cystectomy for bladder cancer. This is in recognition of the potential benefits of neobladder surgery over creation of an ileal conduit related to quality of life (QoL), such as avoiding the need to form a stoma with its cosmetic, psychological and other potential complications. The PubMed database was searched using relevant search terms for articles published electronically between January 1994 and April 2014. Full-text articles in English or with English translation were assessed for relevance to the topic before being included in the review. Patients with neobladders have comparable or better post-operative sexual function than those with ileal conduits. They also have comparable QoL to those with ileal conduits. Orthotopic neobladder is a good alternative to ileal conduit in suitable patients who do not want a stoma and are motivated to comply with neobladder training. However, the selection of a neobladder as the urinary diversion of choice requires that patients have good renal and liver functions and are likely to be compliant with neobladder training. With benefits also come potential risks of neobladder formation. These include electrolyte abnormalities and nocturnal incontinence. This short review highlights current aspects of neobladder formation and its potential advantages.

Keywords: Erectile dysfunction; quality of life; urinary bladder; urinary diversion; urinary incontinence.

Figure 1

Types of urinary diversion surgery; (a) orthotopic neobladder (specifically Hautmann neobladder with chimney ureteroileal anastomosis), (b) ileal conduit, (c) continent ileostomy, and (d) cutaneous ureterostomy. Fenestrated box represents the removed native bladder. (Figure illustrated by Dwayne Chang. Copyright Nathan Lawrentschuk and Dwayne Chang. Reproduced with permission.)