Bladder Reconstruction Surgery

The bladder is a hollow, muscular organ in the lower abdomen that stores urine produced by the kidneys until it is released from the body through the urethra. Bladder cancer develops when urothelial cells lining the inner surface of the organ undergo harmful changes that cause them to grow uncontrollably and form tumors.

Bladder cancer is one of the most frequently diagnosed cancers in the United States, with approximately 82,000 new cases identified each year. Although the exact cause is not always known, the condition affects more men than women, and the risk increases with age, especially after 55. Early symptoms may include blood in the urine, frequent or painful urination and ongoing pelvic discomfort.

Treatment for bladder cancer depends on the stage and biological behavior of the tumor. Management may involve surgery, radiation therapy, chemotherapy, immunotherapy or a combined approach. For muscle-invasive cancer or a high-risk, recurrent non-muscle-invasive tumor that does not respond to other therapies, surgical removal of the bladder, known as radical cystectomy, may be recommended to achieve optimal cancer control.

When is bladder reconstruction surgery considered for bladder cancer?

Because removal of the bladder will disrupt the body’s natural urinary pathway, reconstructive surgery is necessary after radical cystectomy to create a new way for the body to store and eliminate urine. This procedure is designed to preserve continence when possible, protect kidney function and support long-term urinary health and quality of life.

Before recommending a bladder reconstruction procedure, the surgeon will evaluate several important factors, including:

• The location, size and stage of the tumor
• The patient’s kidney and liver function
• The patient’s overall health and ability to tolerate major surgery
• The likelihood of achieving effective cancer control while preserving urinary function
• The patient’s personal preferences related to lifestyle, continence and ease of ongoing care

Often, bladder reconstruction can be performed during the same surgical session as bladder removal. This will allow the patient to begin recovery with a new urinary drainage method already in place, reducing the need for additional surgeries and supporting a more streamlined healing process.

What are the potential benefits of bladder reconstruction surgery?

Bladder reconstruction surgery can restore urinary function after bladder removal by creating a safe and effective pathway for urine storage and elimination. Depending on the technique used, the reconstructed urinary system may allow for a natural pattern of urination through the urethra or provide a dependable urinary diversion that supports the patient’s long-term health and daily living. Each approach is designed to balance cancer control with functional outcomes and quality of life considerations.

Key benefits of bladder reconstruction surgery may include:

• Preservation of urinary independence – Certain reconstruction options, such as an orthotopic neobladder, may allow the patient to urinate through the urethra rather than relying on an external collection system.
• Improved quality of life – Reconstruction can reduce dependence on external appliances and support comfort during daily activities, work and social interactions.
• Protection of kidney health – A properly constructed urinary diversion system will promote safe urine drainage from the kidneys, lowering the risk of infection and long-term kidney damage.
• Long-term durability – Many bladder reconstruction techniques are designed to provide stable, reliable urinary function over time.

Each bladder reconstruction option has unique benefits and potential limitations. The goal is to select the approach that best aligns with the patient’s medical needs, tumor characteristics, lifestyle considerations and personal goals.

What does bladder reconstruction surgery involve?

Bladder reconstruction procedures differ based on the type of urinary diversion created. The three most common reconstruction approaches are the orthotopic neobladder, continent cutaneous reservoir and ileal conduit. Each option uses a segment of the intestine to create a new pathway for urine to flow safely from the kidneys and out of the body.

Orthotopic neobladder

A neobladder is an internal reservoir constructed from a portion of the small intestine and attached to the urethra, allowing the patient to urinate in a way that closely resembles natural bladder function. During the procedure, the surgeon will form a spherical reservoir from bowel tissue. The surgeon will then connect the new bladder to the ureters to receive urine from the kidneys, and to the urethra to enable voluntary voiding.

This type of bladder reconstruction may not be feasible if the cancer involves the urethra or if the patient has certain anatomical considerations or reduced kidney or liver function. The patient must also be motivated and able to participate in rehabilitation exercises to achieve continence.

Continent cutaneous reservoir (continent diversion)

A continent cutaneous reservoir is an internal urine storage pouch fashioned from a segment of intestinal tissue. After creating the pouch, the surgeon will bring a small opening (stoma) to the skin’s surface, allowing access to the reservoir through the abdominal wall.

The pouch will store urine inside the body, eliminating the need for an external collection bag. The patient will empty the reservoir several times a day by inserting a catheter through the stoma. This type of bladder reconstruction supports urinary continence and may improve body image for a patient who prefers an internal solution rather than an external appliance.

Ileal conduit (incontinent diversion)

The ileal conduit is the simplest and most commonly performed type of urinary diversion. During this procedure, the surgeon will use a short segment of intestinal tissue to create a passageway that directs urine from the ureters to a stoma on the abdominal surface, where it will drain into an external collection pouch.

Although an ileal conduit requires an external pouch, it can be a reliable option for a patient who is not a candidate for continent diversion. The procedure typically involves less operative time than other bladder reconstruction techniques and is associated with fewer long-term metabolic risks. Many patients adapt well to this approach and value the consistency and predictability it provides.

How to prepare for bladder reconstruction surgery

Preoperative preparation plays an important role in supporting a safe bladder reconstruction procedure and a smooth recovery. During this phase, the patient may meet with surgeons, oncologists, anesthesiologists and rehabilitation specialists to understand the scope of the surgery, the reconstruction plan and the expected outcome.

Key components of preparation for bladder reconstruction surgery may include:

• Comprehensive medical evaluation – Blood work, imaging studies and kidney and liver function tests can help the surgeon determine the most appropriate reconstruction approach and plan the procedure.
• Stoma site marking (if applicable) – A wound and ostomy care nurse will identify the most comfortable and discreet location for a stoma to support long-term ease of care.
• Nutritional optimization – Dietary adjustments may be recommended to ensure adequate nutrition and promote healing before and after surgery.
• Medication review – The healthcare team will provide guidance on anticoagulants, supplements or other medications that may need to be adjusted or temporarily discontinued.
• Smoking cessation – Avoiding tobacco before surgery can reduce the risk of complications and support healing.
• Education on postoperative expectations – If the patient is preparing for a neobladder or continent diversion, they may receive instruction on voiding techniques or catheterization to build confidence prior to surgery.

What to expect after bladder reconstruction surgery

Bladder reconstruction surgery is followed by a structured recovery process that will begin in the hospital and continue over several weeks to months. During this time, the healthcare team will monitor healing, help the patient adjust to the new urinary system and provide education to help them manage ongoing care with confidence.

Hospital recovery and early postoperative care

Immediately after bladder reconstruction surgery, the patient will remain in the hospital for close monitoring. The length of the stay can vary based on the type of reconstruction performed and the patient’s overall health, but many patients are hospitalized for several days.

During the early postoperative period, the patient can expect:

• Drainage tubes and catheters – Temporary catheters or surgical drains can promote healing of the reconstructed urinary system and help maintain proper urine flow.
• Pain management – The healthcare team may recommend regional anesthesia, medications or enhanced recovery protocols designed to improve comfort while minimizing side effects.
• Mobility and respiratory therapy – Early movement and breathing exercises can help reduce the risk of blood clots and lung complications.
• Dietary progression – The patient will begin with clear liquids and gradually advance to a regular diet as bowel function returns.
• Training and education – Depending on the type of bladder reconstruction performed, the patient will receive tailored instruction on neobladder voiding techniques, catheterization for a continent reservoir or stoma care and pouch management for an ileal conduit.

Support from nurses, ostomy specialists and rehabilitation teams will help ensure the patient is prepared to manage their urinary diversion safely at home.

Ongoing recovery and adjustment

The recovery process will continue over several weeks to months as the patient adapts to the reconstructed urinary system. Fatigue is common after any major surgery and generally improves with rest and gradual increases in activity. The adjustment process can vary depending on the type of bladder reconstruction performed:

• Orthotopic neobladder – The patient may experience changes in urinary control as they learn new muscle coordination techniques and establish consistent voiding patterns.
• Continent cutaneous reservoir – The patient may become more comfortable with routine catheterization as they develop a predictable schedule.
• Ileal conduit – The patient will gain confidence in stoma care as daily management becomes more familiar.

Over time, most patients regain strength, resume normal activities and establish steady routines that support long-term comfort and function.

Possible side effects during recovery

While many patients recover from bladder reconstruction surgery without significant difficulty, some may experience side effects during the adjustment period, including:

• Difficulty emptying the neobladder, which may require intermittent catheterization
• Nighttime leakage during neobladder adaptation
• Mucus production from the intestinal tissue used for the bladder reconstruction
• Skin irritation around the stoma
• Changes in electrolyte balance, particularly with a continent diversion

These effects are typically manageable with guidance from the healthcare team and tend to improve as recovery progresses.

Surveillance and long-term follow-up care

After bladder reconstruction surgery, long-term follow-up care is generally required throughout the patient’s life to maintain optimal urinary and kidney health. Depending on the type of reconstruction performed, follow-up visits may include imaging studies, urine tests, metabolic evaluations and endoscopic assessments.

The goals of follow-up care are to:

• Detect bladder cancer recurrence or new urinary issues early
• Ensure proper function of the urinary diversion
• Identify and manage any complications, such as infections or electrolyte imbalances
• Provide ongoing support for continence, catheterization or stoma care

Regular surveillance can support long-term health, function and quality of life following bladder reconstruction surgery.

Benefit from world-class care at Moffitt Cancer Center

At Moffitt, patients undergoing bladder reconstruction surgery benefit from a multispecialty evaluation and coordinated care that supports both cancer control and long-term urinary health. Our specialists in urologic oncology, reconstructive surgery, rehabilitation, nutrition and symptom management work together to create highly individualized treatment plans. Our team-based approach helps to ensure each patient receives safe surgery, effective cancer care and comprehensive support throughout recovery.

If you would like to learn more about bladder reconstruction surgery, you can request an appointment with a specialist in the Urologic Oncology Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.