What Are The Advantages And Disadvantages Of A Neobladder?

The advantages of a neobladder over a urostomy or continent diversion are primarily lifestyle related and cosmetic. A neobladder is an attempt to replace the bladder with as close to a normal bladder, and therefore lifestyle, as possible. In an ideal situation, the neobladder will function like a normal bladder, storing urine at low pressure and forcing out urine on command by the patient.

The most obvious advantage is that when all goes well there is no need for an external appliance or periodic catheterization. Patients with a urostomy need to wear loose-fitting clothing, but there are no such limitations with a neobladder.

The disadvantages to a neobladder are mostly potential disadvantages. That is, when the procedure goes well and everything works to its full potential, there is little or no disadvantage. Unfortunately, neobladders are prone to some problems that a urostomy is not. The most common potential problem is incontinence. About 90% of patients will be continent during the day, and 80% will be continent at night. This may mean that you will need to wear a diaper or pad if you have troublesome incontinence after surgery, especially at night.

In addition to incontinence, some patients will not be able to empty the neobladder completely when they void. This may mean that intermittent self-catheterization is necessary to empty the neobladder fully.

In order to make a neobladder that is large enough to hold urine for several hours, a longer segment of bowel is needed than for a simple ileal conduit. Patients who have certain bowel conditions may not be able to tolerate the removal of such a large piece and would do better with a short ileal conduit.

Intestine normally secretes a large amount of mucous. When separated and used as a neobladder, the mucous production generally decreases over time. Some patients will continue to produce mucous, which can accumulate and obstruct the flow of urine or cause stones to form. These patients will need to place a catheter into the neobladder and irrigate it free of mucous periodically.

A continent, catheterizable diversion often has a relatively high rate of complications in the first 1 to 2 years. Most of these are related to narrowing of the channel through which the catheter passes, however, and are relatively easy to treat with minor procedures. Only about 2% will fail completely and need to be converted to a urostomy with a bag, whereas about 5% will have problems with leakage of urine.

About 10% will experience complications several years later, including stones, hernias, and bowel obstruc-tions. As with a neobladder, a larger segment of intestine is required to create this type of diversion. Some patients may continue to have troublesome mucous production inside the diversion, requiring daily irrigation to prevent mucous plugs, stones, and infections.

Most studies that directly compare the quality of life after surgery have found that patients are mostly very satisfied with either choice. These studies have shown that neobladder patients are no more or less satisfied than patients with a urostomy bag.

Also, the overall complication rates between the two are similar, although each has its own associated types of complications. Thus, it is important to review carefully the advantages and disadvantages of each to decide which will suit your lifestyle the best.