Orthotopic bladder substitution

Orthotopic neobladder has been a commonly used option for urinary diversion since the 1980s. Advantages of this type of diversion are the ability to avoid an ostomy, voiding function similar to the native bladder, and improved cosmesis. Drawbacks unique to a neobladder include urinary incontinence, incomplete emptying, need for self-intermittent catheterization (SIC), and longer operative times. Indications for orthotopic diversion are: Absence of malignancy of the prostatic urethra in men or the bladder neck in women, adequate renal function (GFR >35-40), normal liver function, absence of severe urethral stricture disease, absence of inflammatory bowel disease (IBD), and a reliable patient with good mental status and dexterity. Many viable surgical techniques exist and offer good functional and oncological outcomes. Robotic intracorporeal neobladder creation has demonstrated similar outcomes to open technique, and represents a promising minimally invasive diversion for the future.