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Patient selection Preoperative consultation
According to Almassi and Bochner (2020) An orthotopic neobladder is a continent
an “orthotopic neobladder represents an diversion in which the patient is taught
excellent option for urinary diversion for the to use pelvic floor muscles and the Valsalva
appropriate candidate.” 69 maneuver to empty their neobladder.
Incontinence is expected in the first 6 months
The fact that a neobladder does not disturb as continence recovery progresses. Ongoing
their body image perception is a strong nocturnal incontinence is experienced by
motivator for many patients. As described many patients. Patients who are unable to
earlier, an Ottawa decision tool helps to fully empty their neobladder, or those unable
guide patients through the decision making to void will need to do clean intermittent
on whether to opt for an ileal conduit or catheterization.
neobladder. These authors recommend
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practitioners to access and utilize this tool While the patient is not expected to have
with their patients as part of the preoperative a stoma, it is imperative all patients should
education and counselling.† nevertheless have preoperative stoma site
marking, and ileal conduit teaching. Based
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There are a number of contraindications on individual centre or surgeon preference
for a neobladder urinary diversion. for the use of a Malecot drain or a suprapubic
Suitable patients for neobladder should catheter, an NSWOC should mark the
have: 70 abdomen to ensure adequate surface area
• a good life expectancy (longer than for adherence of the two-piece pouching
1 to 2 years); system while irrigation is necessary.
• no history of drug or alcohol misuse;
• no cognitive impairment; During the preoperative teaching process, the
• adequate renal function (estimated patient/significant other should be given the
glomerular filtration rate [eGFR] opportunity to have hands-on demonstration
>40 mL/min); and practice with the irrigation equipment.
• dexterity and willingness for intermittent This will allow the patient/significant other
catheterization; to more fully appreciate the care and
• normal hepatic function; time commitment involved in the early
• a competent external sphincter; and postoperative period; and allow an NSWOC
• negative intraoperative urethral margin to assess their cognitive and fine motor
on frozen section. skills. A discussion on pelvic floor exercises
to aid in bladder emptying and continence
Neobladder is less common than ileal recovery should occur. In the event the patient
conduit in the elderly, although it is not is unable to void, an NSWOC should also
a contraindication. Neobladder may be review the technique for clean intermittent
associated with longer recovery of urinary catheterization and provide the patient/
control or risks of nocturnal incontinence with significant other the opportunity to practice
increasing age. 71-73 Urinary retention being with the equipment involved.
more common in women. 74
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