What is Radical Cystectomy and Orthotopic Neobladder?
Radical cystectomy is the primary surgical treatment option for muscle-invasive bladder cancer. During radical cystectomy, the cancerous bladder tissue and surrounding lymph nodes are completely removed. Once the bladder is removed, urinary diversion must be established. An orthotopic neobladder involves creating a new urinary reservoir using a 40-50 cm segment of the patient's own small intestine and anatomically reconnecting it to the native urethra.
What are the Advantages of Orthotopic Neobladder Surgery?
In traditional urinary diversion methods (ileal conduit), urine flows into an external plastic bag attached to the abdominal wall. The orthotopic neobladder technique completely eliminates the need for an external appliance.
- Natural Micturition Route: Patients void urine through their natural urethral pathway.
- Cosmetic and Psychological Comfort: Body image and self-esteem are preserved since no external bag is visible.
- Freedom of Social Activity: Daily physical activities, swimming, and sports can be carried out without external restrictions.
Who is an Eligible Candidate for a Neobladder?
Neobladder reconstruction may not be suitable for every patient. Specific oncological and physiological criteria must be evaluated:
- Absence of tumor involvement in the urethra or urethral margin
- Adequate renal and hepatic function
- Healthy small intestine structure and normal absorptive capacity
- Physical and cognitive capability to perform post-operative pelvic floor exercises
Neobladder Surgery and Procedure in Adana
Performed for advanced bladder cancer cases in Adana and the surrounding region, orthotopic neobladder surgery is a complex reconstructive procedure requiring high surgical precision. The operation can be performed via open, laparoscopic, or robotic surgical approaches.
During surgery, the resected bowel segment is detubularized and reshaped into a spherical, low-pressure, high-capacity reservoir. The ureters coming from the kidneys are reattached to this new pouch, which is then sutured to the native urethra.
Post-Operative Recovery and Adaptation
Since the new reservoir is made of intestinal tissue, it lacks the natural detrusor muscle contraction reflex. Therefore, patients must learn how to void intentionally by relaxing the pelvic floor muscles and applying gentle abdominal pressure.
- Timed Voiding: Patients are advised to void on a strict schedule (every 2-3 hours) during early recovery.
- Pelvic Floor Muscle Training: Regular Kegel exercises help achieve day and night urinary continence.
- Hydration: High fluid intake is essential to flush out intestinal mucus secretions and lower infection risk.