Reconstructive Bladder Surgery

Some patients with bladder cancer need to have reconstructive surgery as part of their treatment.1-3 When a patient has surgery called a radical cystectomy, the surgeon removes the entire bladder. The surgeon then uses reconstructive surgery to create a new way for the body to store and pass urine. Patients who have metastatic bladder cancer that has spread to other parts of the body may also need to have reconstructive surgery without removing the bladder. For those patients, the surgery is performed to help improve the patient’s urine flow and the cancer itself is treated in other ways, such as chemotherapy.

There are 3 options for reconstructive bladder surgery

There are several different types of reconstructive surgery for bladder cancer patients, each of which has advantages and disadvantages. The healthcare providers on your cancer care team will discuss all of the available options with you so you can make the choice that is best for you. The available options will depend upon factors such as a patient’s age, general health, and type of cancer.

Types of urinary diversions

Reconstructive surgeries in bladder cancer are also called urinary diversion procedures. Types of reconstructive surgery include:

  • Incontinent diversion
  • Continent diversion
  • Neobladder

Figure 1. Different tyes of bladder reconstruction

Three human figures showing an ileal conduit with an external pouch compared to the internal Indiana Pouch compared to the pouchless neobladder

What is an ileal conduit (IC)?

During an incontinent diversion procedure, the surgeon uses a small piece of the patient’s intestine to create an ileal conduit.2 An ileal conduit is a way for urine to pass from the kidneys and out of the body. Urine flows from the kidneys and through the ureters, which connect the kidneys to the bladder. In patients who have had their bladder removed, one end of the ileal conduit is connected to the ureters and the other is connected to an opening in the skin on the abdomen. This opening is called a stoma or urostomy. A small bag attached to the stoma collects small amounts of urine that flows out of the body through the ileal conduit. The patient empties the small bag when it is full and reattaches it to the stoma.

What is an Indiana pouch (IP)?

During a continent diversion procedure, also known as the Indiana pouch, the surgeon creates a small pouch using a small piece of the patient’s intestine.1,2 One end of this pouch is attached to the ureters and the other end is attached to a stoma on the abdomen. The surgeon creates a valve in the pouch so it can store urine, which can be emptied by attaching a catheter (drainage tube) to the stoma. This procedure is different than incontinent diversion because the patient does not have an external bag storing urine outside the body. Continent diversion is also called a continent cutaneous pouch.

What is a neobladder?

A newer type of reconstructive surgery is called a neobladder.2 Like continent and incontinent diversion procedures, the surgeon connects a small piece of the patient’s intestine to the ureters. This piece of intestine is called a neobladder because it is used to store urine. Unlike those other procedures, the other end of the neobladder is attached to the urethra, which is the hollow tube-like organ that allows urine to flow out of the body from the bladder. Because the neobladder is attached to the urethra, many patients are able to urinate in a normal way after they recover from surgery.

Side effects of reconstructive surgery in bladder cancer

Bladder cancer patients who have had reconstructive surgery may experience side effects, such as urine leakage, pouch stones, and problems with urination.2 It can take time to adjust to lifestyle changes that result from the surgery, as patients may need to learn how to use their urostomy bag or catheter. Your healthcare providers will provide guidance and support in dealing with these types of issues.

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Written by Anna Nicholson | Last review date: September 2021.