Neobladder Surgery: Controlling Urination After Bladder Removal - Urology

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Artificial bladder


Hello Doctor: My father has been diagnosed with bladder cancer and needs to undergo a radical cystectomy.
He is now considering whether to use a segment of his intestine to create a neobladder.
I would like to ask if, after the creation of the neobladder and with training, he will be able to control urination? Or is it still very likely that he may experience incontinence despite training?

Bao, 20~29 year old female. Ask Date: 2017/05/04

Dr. Du Shixi reply Urology


A physician must not perform treatment, prescribe medication, or issue a diagnosis without a personal examination.
Hello: If the stoma for an artificial bladder is located on the abdomen, some patients may require a urinary bag.
Currently, there are procedures to create a new artificial bladder that can be reconnected to the urethra, with the goal of allowing the patient to urinate independently.
However, whether the outcome is ideal—such as experiencing difficulties in urination or incontinence—depends on the surgical procedure and the patient's individual circumstances, as these types of surgeries are typically performed in large hospitals.
The duration of the surgery is also considerable, and there will be a thorough surgical explanation prior to the procedure.
You can discuss this with your attending physician.
The website of Hsin-Chu Hospital has a section regarding surgical explanations for bladder cancer, which you can refer to: http://www.kfsyscc.org/cancer/urologic-oncology/therapy/surgery/.

Reply Date: 2017/05/04

More Info


Neobladder surgery, which involves creating a new bladder from a segment of the intestine after the removal of the bladder due to cancer, is a significant procedure that can greatly impact a patient's quality of life. Your father's situation, where he is considering this surgery after a diagnosis of bladder cancer, is not uncommon. Understanding the implications of this surgery, particularly regarding urinary control, is crucial.

After the creation of a neobladder, many patients can regain some degree of urinary control, but the extent of this control can vary significantly from person to person. The new bladder, made from intestinal tissue, is designed to function similarly to a natural bladder. However, it may not have the same capacity or the same ability to signal the brain when it is full. This can lead to challenges in controlling urination.

Training is an essential part of the recovery process. After surgery, patients typically undergo a rehabilitation phase where they learn to manage their new bladder. This training often includes techniques to recognize the urge to urinate and strategies to strengthen the pelvic floor muscles. Many patients find that with time and practice, they can improve their control over urination. However, it is important to note that some individuals may still experience issues such as urgency, frequency, or even incontinence despite undergoing training.

The likelihood of achieving good urinary control after neobladder surgery can depend on several factors, including:
1. Surgical Technique: The skill and experience of the surgeon play a significant role in the outcome. A well-performed surgery can lead to better functional results.

2. Patient Factors: Individual anatomy, pre-existing conditions, and overall health can influence recovery. For instance, patients with a history of urinary issues may face more challenges.

3. Postoperative Care: Following the surgeon's recommendations and participating in rehabilitation programs can enhance recovery. Regular follow-ups with healthcare providers are crucial to monitor progress and address any complications.

4. Psychological Factors: Anxiety and stress can affect bladder control. Psychological support may be beneficial during the recovery process.

While many patients do regain a satisfactory level of control, some may experience complications such as urinary incontinence. This can occur due to various reasons, including the inability of the neobladder to store urine effectively or issues with the sphincter mechanism. In some cases, additional interventions, such as medications or pelvic floor therapy, may be necessary to manage these symptoms.

In summary, while there is a good chance that your father can regain control over urination after neobladder surgery, it is not guaranteed. The process involves training and adaptation, and outcomes can vary widely. It is essential to have open discussions with the surgical team about expectations, potential complications, and the rehabilitation process. They can provide tailored advice and support to help your father navigate this significant life change.

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