Orthotopic Neobladder

For patients undergoing robotic cystectomy for bladder cancer, formation of an orthotopic neobladder allows internalisation of the urinary tract and avoidance of a stoma.

Orthotopic means “in the same place” and neobladder means “new bladder”, which involves creating a reservoir from loops of small bowel and placing this in the same location as the “old” bladder. The kidneys, ureters and urethra are then connected so as to replicate as closely as possible the normal anatomy of the urinary tract.

Is avoidance of an external collection pouch (stoma) and allows the patient to empty the neobladder by urination.

However the neobladder is a substitute; and it does not work exactly like a regular bladder, particularly early in the post-operative period where the capacity of the neobladder is relatively small. This means frequency, urgency and incontinence may be experienced until the capacity of the neobladder increases over time. It is a more complex procedure than an ileal conduit, and there is a higher chance of complications including urine leak, urinary retention, stones and metabolic issues.

Nevertheless, in a young, motivated patient an orthotopic neobladder offers an excellent option following robotic cystectomy by maintaining the normal urinary drainage pathway and avoiding a stoma. At Sydney Urology Group, our surgeons can perform the orthotopic neobladder utilising the robot, known as intracorporeal. Traditionally an open approach has been used to create this urinary diversion, known as extracorporeal, and there remains controversy as to whether one method is superior to the other in terms of post-operative recovery, bladder function, and complications.

At Royal Prince Alfred Hospital and Chris O’Brien Lifehouse a randomised control trial is currently underway comparing these two techniques, Urinary Diversion Intracorporeal Versus Extracorporeal Randomised Trial (UDIVERT).

Figure 1. – Neobladder