Bladder Replacement

A Neobladder is a urinary pouch made from a piece of intestine. During surgery, the bladder and prostate are removed and the chosen segment of intestine is opened lengthways and then stitched together to form the new bladder.

The left and right ureters are implanted into the Neobladder allowing urine to drain into the Neobladder directly from the kidneys. The urethra is then anastomosed onto the base of the neobladder to allow normal passage of urine.

The muscles in your new bladder will not work in the same manner as a normal bladder. Initially you may not have complete control and you will be instructed on pelvic floor exercises to strengthen the muscles. The capacity of your new bladder will increase over time and it may take up to 3-6 months.

Before surgery

  • Ensure your hospital paperwork is completed and sent to the hospital at least 7 days before surgery.
  • Ensure you have all your tests completed 4-7 days before surgery. These include bloods, ECG and urine test.
  • Arrange to see a Continence Physiotherapist for Pelvic floor exercises – details will be provided by the Practice Nurse.
  • You will be admitted the day before surgery approximately 2PM to enable commencement of bowel preparation at 4PM.
  • You will be seen by the Stomal Therapist for siting of a stoma if surgery is unsuccessful (this is routine only).
  • Once admitted, you will be issued with anti-embolic stockings (compression stockings). You are required to wear these throughout your admission and at home up until the day you return to have your catheter removed.
  • If you are a Diabetic, please speak to the Practice Nurse at your earliest convenience.
  • If you are on any blood thinning medications, then please alert the nurse at your earliest convenience.
  • Please inform staff if you have any allergies.

You will remain in hospital 10-14 days. Before discharge, you will be taught how to look after your catheters (urethral and suprapubic) and how to flush your suprapubic catheter. The bowel produces mucous. It is important you regularly flush you catheter to avoid mucous obstruction and to allow urine to flow freely. The hospital will advise you on procedure and frequency of flushes. Written instructions will be provided to you by the hospital.

You will return to the hospital to have your catheter removed (Trial of void) approximately 3 weeks following surgery. The date for this will be given to you by the nursing staff on the day you are discharged.

Following discharge and before readmission to have catheters removed (Trial of Void)

  • It is normal to feel tired following surgery. It is important you get plenty of rest, eat a well-balanced diet and do gentle exercises such a walking. Avoid stairs if possible.
  • Ensure your bowels are regular. A high fibre diet with adequate fluids is essential. Avoid constipation as this may cause discomfort whilst the catheters are in place.
  • Sometimes mild laxatives are required. Speak to the Practice Nurse for further advice.
  • Take regular pain relief as required. Avoid codeine as this may cause constipation.
  • Your wound dressing will be removed before discharge. Your sutures are dissolvable and therefore will dissolve within 1-2 weeks. Please call the rooms if you notice redness, swelling and or discharge from the wound.
  • It is important you drink adequate fluids and to ensure your urine is pale yellow during the day and that you flush your suprapubic catheter as advised/taught.
  • You are required to have a urine culture taken before readmission… Instructions will be provided to you by the hospital before discharge. This test will check if you have a urinary tract infection. Antibiotics will need to be prescribed and taken at least two days before readmission to hospital.

Readmission for Trial of Void

  • You will return to the hospital to have your catheters removed. This will be an overnight admission.
  • Your urethral catheter will be removed and you will be taught how to empty your bladder
  • Your neo bladder will not have a strong muscular contraction and therefore, will not have the usual bladder sensation. This means you will not have the same degree of urgency and pressure when your bladder reaches capacity.
  • Initially, your bladder control will be reduced. You will notice your new bladder will have a small capacity and the new bladder outlet may not be watertight.
  • You may notice some incontinence. The degree of incontinence varies from person to person.
  • You will be instructed on how to pass a catheter (intermittent catheterisation) to help empty your bladder as well as clear any mucous. The frequency of catheterisations will be determined by your doctor. The frequency of flushes will be determined by your doctor and nursing staff.
  • You will be instructed to empty your bladder 2-3 hourly during the day and 2-3 hourly overnight and to use techniques such as external abdominal pressure to help empty your new bladder or sit to empty your bladder, relax the pelvic floor whilst contracting the muscle inside your abdomen. This will put pressure on your bladder and will help empty your bladder.

Following discharge from your Trial of Void

  • You are advised to avoid heavy lifting for 6 weeks and any strenuous exercise or activities for 6 weeks. Strenuous exercise includes bike riding, running, horse ring and golf. Avoid stairs for the first few weeks.
  • Continue to have plenty of rest and eat a well-balanced healthy diet.
  • Drink 2 litres of fluid per day to ensure your urine is pale yellow and to help flush out your bladder.
  • Continue to pass your catheter as recommended by your doctor. As you bladder capacity increases, passing urine improves, so does the frequency of catheters.
  • Continue to use techniques taught in hospital.
  • Recommence pelvic floor exercises as previously discussed by the Continence Physiotherapist.
  • If you are incontinent it is important you wear appropriate pads as advised by hospital staff or the Practice Nurse. In some cases, a mattress protector and barrier creams are also required.
  • It is important you maintain a record (bladder diary) for the first few weeks. This includes the time and volume of urine passed, time catheter passed and volume drained (for both day and night). This will help the doctor determine how you are progressing
  • Return to work is dependent on the type of work you do. Generally being off work for 6 weeks is recommended. If you wish to return earlier, you will need to discuss this with your surgeon.
  • No driving is allowed for 6 weeks.
  • You are required to return to the rooms for your first appointment following surgery approximately 4 weeks following removal of your catheters (Trial of Void). Please call the rooms if this appointment has not been made.

You must contact the rooms if you experience any of the following:

  • Redness, swelling and presence of purulent discharge from the wound
  • Fever, chills, sweats
  • Cloudy, offensive urine
  • Decreased or no urine output
  • Loss of appetite
  • Swelling and redness in your legs
  • Shortness of breath/back pain
  • Severe abdominal, back or flank pain.