Rigi10™ Malleable Penile Prosthesis
Also Known As
Orthotopic neobladder, Ileal neobladder, Orthotopic urinary diversion, Continent urinary diversion, Bladder substitution, Neovesica
Definition
A neobladder is a surgically created reservoir for urine made from intestinal tissue after bladder removal (cystectomy). This orthotopic urinary diversion technique involves reconfiguring segments of the small intestine, typically the ileum, into a spherical pouch that functions as a replacement bladder.1 The neobladder is positioned in the original bladder location and connected to both the ureters (which carry urine from the kidneys) and the urethra, allowing for the storage of urine within the body and voluntary voiding through the natural urethral channel.2 The primary purpose of a neobladder is to maintain continence and preserve quality of life by enabling patients to urinate in a manner similar to normal physiological function following bladder removal.3 Over time, the intestinal tissue undergoes a maturation process, with structural and ultrastructural changes in the ileal mucosa leading to a primitive epithelium similar to urothelium, enhancing its function as a urinary reservoir.4
Clinical Context
Neobladder reconstruction is primarily indicated for patients undergoing radical cystectomy for muscle-invasive bladder cancer, which represents the most effective treatment with 5-year cancer-specific survival rates reported up to 76%.1 Other indications include chronic bladder pain or dysfunction due to injury, surgery, or radiation that necessitates bladder removal.2 Patient selection is critical for successful outcomes, with ideal candidates being motivated individuals with adequate renal function, no tumor involvement of the urethra, and good overall health status.3
The surgical procedure involves removing the bladder (cystectomy), typically with bilateral pelvic lymph node dissection, followed by isolating a segment of small intestine (usually 40-60 cm of ileum) while preserving its blood supply.4 This intestinal segment is then reconfigured into a spherical reservoir, placed in the original bladder location, and connected to both the ureters and urethra.5 The procedure can be performed through traditional open surgery or using minimally invasive techniques such as robotic-assisted surgery, with operative times typically ranging from 2-6 hours.5
Postoperatively, patients require a urinary catheter for approximately three weeks to allow for healing.2 Recovery involves learning new voiding techniques using abdominal muscles and may require pelvic floor exercises to improve continence.5 Clinical outcomes show that more than 90% of patients achieve daytime continence within 12-18 months, while over 50% achieve nighttime continence within 18-36 months post-surgery.5 Approximately 10-15% of patients may require intermittent self-catheterization due to difficulty emptying the neobladder completely.5