The most important part of the decision-making process is to talk with your urologist openly about your concerns. The two of you should decide together which option is best given any other medical problems, lifestyle, manual dexterity, and mobility, as well as the specifics of your tumor.
A neobladder is often recommended for younger, healthier patients, although there is no age limit to the procedure.
A neobladder requires a commitment by the patient to learning a new way to urinate, maintenance of a degree of physical fitness, and the ability to get to the bathroom at regular intervals. A neobladder is not appropriate in a patient who has poor mobility (i.e., after a stroke, spinal cord injury, severe arthritis, etc.).
Patients who are not mobile or have other serious medical conditions or who just want the simplest option will do better with an ileal conduit. Obese patients and those who have had multiple abdominal surgeries or trauma may have a difficult time getting the ostomy bag to seal properly, causing leakage.
A visit with a specially trained ostomy nurse can help decide the ideal location in these patients to ensure a proper fit of the bag.
A continent urinary diversion has become a less common choice since the popularization of the neobladder. A continent urinary diversion requires that a patient have adequate manual dexterity and strength to catheter-ize the pouch several times a day, every day for the rest of their lives. Most patients who fit this category will be better served by a neobladder.
Patients who have, for example, arthritis in their hands or poor vision may have a difficult time performing the catheterization, especially several years down the road. These types of patients again would be wise to choose an ileal conduit.
Although many physicians believe that an ileal conduit has the fewest complications, recent studies have not sup-ported this. In fact, all three options have similar compli-cation rates over the long term. Neobladders tend to have more problems early on, whereas ileal conduits develop problems later, which has likely led to the mistaken beliefs.
Patient says:
When I was diagnosed with bladder cancer, I was given the recommendation to have a radical cystectomy and an ileal conduit by my local urologist. I am a very active female who loves to travel. I still take care of myself by exercising and watching my weight. I used to smoke when I was younger but had quit many years before my diagnosis of invasive bladder cancer. The thought of having a stoma and wearing a bag was not a great option for me.
I was middle age but didn’t think that I acted old. I chose to get a second opinion to see if there were any other options for me and was offered the option of a continent urinary diversion, an Indiana Pouch. I catheterize the pouch several times a day to drain it. There is a very small opening on my abdomen through which I pass the catheter.
I have no leakage of urine from the opening. The doctor who performed my Indiana Pouch had warned me that there were more complications associated with the Indiana Pouch, and I have experienced several. I developed a blockage where the ureter, the tube that drains my kidney, joins the pouch on each side; this required surgery. Despite these complications and the need for additional surgeries, I still am happy to not have to wear a bag.