Neobladder “Function”: Tips and Tricks for Surgery and Postoperative Management

Abstract

Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).

Advances in Urinary Diversion: From Cutaneous Ureterostomy to Orthotopic Neobladder Reconstruction—A Comprehensive Review

“…In terms of the ideal neobladder characteristics, existing literature underscores the importance of appropriate capacity, low-pressure storage, absence of reflux, and high compliance in order to promote continence while enabling voluntary voiding. The spherical configuration of the reservoir has been acknowledged as a favorable choice due to its capacity to hold larger volumes at lower pressures while also addressing concerns regarding electrolyte exchange [147]. However, it is important to note that an excessively large initial volume might not necessarily improve continence rates and could lead to progressive enlargement, resulting in atony and voiding difficulties [148].…”

Prevention and management of urinary tract infections after cystectomy

“…Another possible explanation is attempted by a study of Fasanella et al An elevated urinary calcium level secondary to metabolic acidosis may predispose patients with ONB to an increased risk of urinary stones, often composed of struvite, secondary to organisms such as the Proteus and Klebsiella spp. Also, urinary retention with the need for self-catheterization occur more frequently [29]. Other authors believe that the inflammatory response or the mucosal architecture of the bowel segment is responsible for the early postoperative UTI rate [30].…”