Neobladder
A new bladder made from a piece of small bowel and joined to the urethra after the bladder is removed for cancer, so you pass urine through the usual opening without a bag. Emptying it is a learned skill: you relax and gently push with your belly muscles.
Also called orthotopic neobladder, new bladder, bladder made from intestine, ileal neobladder, Studer pouch, Studer neobladder, Hautmann neobladder, orthotopic urinary diversion
- Where
- Hospital operating room
- Anesthesia
- General anesthesia, often with a nerve block or epidural for pain control
- Time in the room
- 5 to 8 hours
- Hospital stay
- Usually 5 to 8 days
- Going home with
- A catheter in the urethra, sometimes with a second tube through the lower belly, for about 2 to 3 weeks; stents for 1 to 3 weeks
- Back to normal
- About 3 months; bladder control keeps improving for 6 to 12 months
- Back to work
- 8 to 12 weeks, depending on the job
Overview
After the bladder is removed for cancer, a neobladder is one way to rebuild the urinary tract. The surgeon takes a longer piece of small bowel, opens it, and folds and sews it into a round pouch. The ureters (the tubes from the kidneys) are joined to the pouch, and the pouch is joined to the urethra where the old bladder used to sit. You urinate through your own urethra, and no bag is worn.
A neobladder works differently from the bladder you were born with. It has no squeezing muscle and does not send the usual urge signal. Instead you feel a vague fullness or pressure in the belly, and you empty it on a schedule by relaxing your pelvic floor and gently tightening your belly muscles. It takes months of practice for the neobladder to stretch and for you to learn how to use it.
Most people are dry during the day by about a year. Leaking at night is more common, because the muscles that keep you dry relax during sleep. The bowel lining keeps making mucus, which shows up as white strands in the urine. Some people, more often women, cannot empty fully and need to pass a thin catheter themselves.
Not everyone can have a neobladder. It needs a urethra free of cancer, kidneys and liver that work well, and a willingness to follow a schedule and do pelvic floor exercises. The rest of the operation, removing the bladder and lymph nodes, is the same as for an ileal conduit.
The parts of your body involved
Urine made by the kidneys flows down the ureters into the bladder, which stores it until you choose to empty it through the urethra. What keeps you dry is mostly a ring of muscle around the urethra just below the bladder, called the external sphincter. In men it sits just beneath the prostate; in women it surrounds the middle of the short urethra. A neobladder depends on keeping this sphincter and the urethra healthy, because they become your new way to hold and release urine.
- Bladder
Removed with the cancer. The neobladder is built to sit in its place.
- External sphincter
The ring of muscle around the urethra that you squeeze to stay dry. Protecting it during surgery is the key to bladder control afterward.
- Urethra
The tube to the outside. It must be free of cancer, and it is joined to the neobladder.
- Prostate (men)
Removed with the bladder. The urethra is cut just below it to keep as much length and sphincter as possible.
- Ureters
Cut near the old bladder and joined to the neobladder.
- Ileum
The last part of the small bowel. A longer piece than for a conduit is borrowed to build the new bladder.
Why it’s done
A neobladder is chosen by people who need their bladder removed and want to keep urinating through the urethra without wearing a bag. It is the closest thing to a natural bladder that surgery can offer.
- Bladder cancer that needs cystectomy
Muscle-invasive cancer, or high-risk early cancer that has not responded to BCG, when the urethra is free of cancer.
- No outside bag
Many people value keeping their body image and passing urine the usual way.
- Good kidney and liver function
The bowel lining absorbs some salts and acid from stored urine. Healthy kidneys and liver handle this; weak kidneys may not.
- Ability to learn and catheterize
You need to follow a voiding schedule, do pelvic floor exercises, and be willing and able to pass a catheter yourself if the neobladder does not empty fully.
- No major bowel disease or heavy past pelvic radiation
Inflammatory bowel disease, prior high-dose pelvic radiation, or a weak sphincter can make a neobladder less likely to work well.
Other options
- Ileal conduit
A short piece of bowel carries urine to a stoma on the belly and into a bag. It is the simplest diversion, with the quickest recovery and the fewest long-term problems.
- Continent pouch with a small stoma
An internal pouch you empty with a catheter through a small opening on the belly, several times a day. An option when the urethra cannot be used.
- Bladder-sparing chemoradiation
For selected muscle-invasive cancers, a thorough TURBT followed by radiation with chemotherapy can keep your own bladder, with lifelong cystoscopy and surgery held in reserve.
- Partial cystectomy
Removing only the part of the bladder with the tumor. Suitable for very few bladder cancers.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Anesthesia, positioning and the robot
You are given general anesthesia. For robotic surgery, you lie on your back with the table tilted steeply head-down, and the robotic arms are attached once the ports are in. Your surgeon sits at a console nearby. A catheter is placed in your bladder.
More detail
Neobladders are also built through open surgery with one incision down the middle of the belly. Many robotic surgeons now build the whole neobladder inside the body.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Waking up
You wake with a catheter in the urethra, possibly a second tube in the lower belly, stents, an IV and perhaps a drain. A strong urge or spasms are common.
- Flushing the catheter
The bowel lining makes thick mucus that can block the catheter. Nurses flush the neobladder with salt water several times a day and teach you and a family member to do it.
- Moving early
Walk the evening of surgery or the next morning, and aim for 4 or more walks a day. Walking helps the bowels, lungs and circulation.
- Eating
Sips of liquid start early and food is added as the bowels wake up. Passing gas is a key sign of progress.
- Pain control
A nerve block or epidural, acetaminophen, anti-inflammatory medicine when safe, and as little opioid as possible.
- Preventing blood clots
Leg squeeze sleeves and blood thinner shots, which usually continue at home for about 4 weeks.
- Going home
Usually 5 to 8 days after surgery, once you are eating, walking, and you or a helper can flush the catheter.
At home
- Catheter care and flushing
Flush the catheter with sterile salt water as you were taught, usually 2 to 4 times a day, and any time urine stops draining. Use a leg bag by day and a larger bag at night.
- Catheter removal
After about 2 to 3 weeks, an X-ray with dye (cystogram) checks that the joins have healed. If there is no leak, the catheter is removed in the clinic.
- Learning to empty
Sit to urinate, men included at first. Relax your pelvic floor, then gently tighten your belly muscles or press with a hand low on your belly until the flow stops. Empty every 2 hours by day at first, then lengthen the gap by about 30 to 60 minutes each week, aiming for every 3 to 4 hours.
- Nights
Set an alarm to empty every 3 hours at night at first. Pads or protective underwear help. Do not let the neobladder overfill, because it can stretch too far and become harder to empty.
- Pelvic floor exercises
Keep doing them several times a day. They help daytime control return sooner.
- Fluids and salt
Drink about 8 to 10 cups a day to thin the mucus and avoid dehydration. Your team will check your blood for acid and salt balance, and some people need sodium bicarbonate tablets.
- Eating and bowels
Small, frequent meals with plenty of protein. Avoid constipation, since straining can stress the new joins.
- Activity, lifting and driving
Walk daily. Do not lift more than about 10 pounds for 6 weeks. Most people drive again after 2 to 4 weeks, once off opioid pain medicine. Avoid baths and swimming until the incisions are healed.
- Blood thinner shots
Continue them for the full course, usually about 4 weeks.
- Sex
Usually after about 6 weeks. Men may need medicines, injections or devices for erections, and orgasm happens without fluid. Women may notice vaginal changes; lubricants and a pelvic floor therapist help. Empty the neobladder first.
Recovery timeline
- Before surgeryChemotherapy, if recommended
About 2 to 4 months of cisplatin-based chemotherapy, then surgery 4 to 8 weeks later. Start pelvic floor exercises.
- Day 0Surgery
Most of the day in the operating room. You wake with a catheter and stents.
- Days 1 to 4Walking, eating, flushing
Walking several times a day, first foods, and learning to flush the catheter.
- Days 5 to 8Home with a catheter
Most people go home once eating and able to manage the catheter with help.
- Weeks 2 to 3Catheter out
After an X-ray confirms healing, the catheter comes out and you start your emptying schedule. Expect to leak and wear pads at first.
- Weeks 3 to 8Small and frequent
The neobladder holds only a small amount at first, so you empty often. Mucus is heavy. Energy slowly returns.
- 3 monthsDaytime control improving
Many people need fewer pads during the day. The first follow-up scan is often around this time.
- 6 to 12 monthsCapacity grows
The neobladder stretches to hold about 2 cups. Most people are dry or nearly dry by day; nights continue to improve.
- Long termRegular checks
Scans and blood tests for kidney function, acid balance and vitamin B12, plus checks of the urethra for cancer.
What it feels like
A neobladder asks more of you in the first year than a conduit does. People who do well with it tend to be patient, follow the schedule, and keep up their pelvic floor exercises. Most say it was worth the work.
Making the choice
Hope at the idea of no bag, mixed with worry about leaking or failing at it.
What helpsAsk your surgeon how many neobladders they build and what their patients' control looks like at 1 year. Talking to someone who has one helps.
Waking up
Tubes everywhere, a sore belly, spasms, and sometimes a feeling of needing to urinate even with a catheter in.
What helpsAsk for medicine for spasms and pain early. The urge fades as the joins heal.
Flushing at home
The thick mucus and the flushing routine can feel unpleasant and a little scary at first.
What helpsThe mucus is normal and expected. After a few days most families find flushing quick and routine.
The day the catheter comes out
Excitement, then often discouragement when you leak more than you expected.
What helpsLeaking in the first weeks is normal while the neobladder is small and the sphincter recovers. It improves month by month.
Learning a new feeling
There is no familiar urge, only vague fullness, belly pressure or a sense of bloating. Some people find this hard to read.
What helpsUse the clock rather than waiting for an urge. Over time most people learn their own signals.
Nights
Alarm clocks, broken sleep and wet pads are the most frustrating part for many people.
What helpsEmpty right before bed and use an alarm. Cut back fluids in the 2 hours before bed but drink well during the day. Night control often keeps improving into the second year.
The turning point
Somewhere around 3 to 6 months, many people notice they are leaking less and can go longer between trips.
What helpsKeep up the exercises and the schedule. Small gains add up.
If you need a catheter
Being told you need to pass a catheter yourself can feel like a setback.
What helpsSelf-catheterization takes a minute or two, is done a few times a day, and protects your kidneys and the neobladder. Most people adapt quickly.
How well it works
Success means the cancer is removed, and you can hold urine for several hours and empty it well through the urethra, staying dry most or all of the time. Control improves gradually over the first year or two.
- Daytime control
Most people, roughly 8 to 9 in 10, are dry or nearly dry during the day by 1 year.
- Nighttime control
Harder to achieve. Roughly 6 to 8 in 10 people are dry at night by 1 year, many with an alarm. Some use a pad at night long term.
- Emptying well
A quick bladder ultrasound after you urinate shows how much is left behind. If a lot is left on a regular basis, self-catheterization is recommended.
- Blood tests
Regular checks of kidney function, acid balance, salts and, after a few years, vitamin B12.
- Cancer follow-up
Scans every 3 to 6 months for the first 2 to 3 years, then yearly. Urine or urethral wash tests check for cancer in the urethra.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Common in the first months and at night. Improves with time, pelvic floor exercises and timed emptying.
White strands in the urine are normal and lifelong, though they lessen. Mucus can block a catheter early on, which is why flushing matters.
Bacteria often live in a neobladder without causing harm. Infections with fever or pain are treated with antibiotics.
Bloating, nausea and vomiting while the bowels wake up after surgery.
Often for dehydration, infection or slow bowels.
Most men have weaker erections unless nerves could be spared, and no man ejaculates fluid. Women may notice vaginal shortening or dryness.
Less common
Some people need to pass a catheter themselves, either a few times a day or long term. This is more common in women than in men.
The bowel lining absorbs some acid and salt from stored urine. This can cause tiredness, poor appetite or deep breathing, and is treated with fluids and bicarbonate tablets.
Early on, urine can leak where the neobladder joins the urethra or ureters, usually treated by leaving the catheter in longer. Months later, scar tissue at a join can block flow and may need a scope, stent or surgery.
Prevented with walking, leg sleeves and blood thinner shots for about 4 weeks.
Can develop years later because part of the bowel is used. Checked with blood tests and treated with shots or high-dose pills.
As with any cystectomy, a small number of people die within 90 days, more often older people and those with other serious illnesses.
Rare
Overfilling or a hard blow to the belly can tear the neobladder. This is an emergency and usually needs surgery.
A channel can form between the neobladder and the vagina in women, or the rectum, causing leakage. Repair needs surgery.
Mucus and staples can act as a seed for stones. They are removed with a scope.
Cancer can rarely return in the remaining urethra, which is why it is checked during follow-up.
Scar tissue can kink the bowel, sometimes years later.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills.
- Your catheter stops draining and flushing does not clear it within 1 hour, or your lower belly feels full and painful.
- After the catheter is out, you cannot empty the neobladder, by straining or with a catheter: go to the emergency room and tell them you have a neobladder.
- Sudden severe belly pain, especially after a fall, a blow to the belly, or a long time without emptying.
- Repeated vomiting, a swollen hard belly, or no gas or stool for more than 2 days.
- Unusual tiredness, weakness, confusion, or deep fast breathing, which can be signs of acid buildup or dehydration.
- Redness, swelling or pus at an incision, or new pain in your back or side.
- Pain or swelling in one leg, or sudden chest pain or shortness of breath: call 911.
Questions to ask your surgeon
- Am I a good candidate for a neobladder, and what could make it a poor fit for me?
- How many neobladders do you build each year, and do you build them robotically or open?
- What daytime and nighttime control do your patients have at 1 year?
- What happens if cancer is found at the urethra during surgery?
- Can my nerves be spared, or for women, can the uterus and vagina be kept?
- How long will the catheter stay in, and who will teach my family to flush it?
- Will I see a pelvic floor physical therapist before or after surgery?
- How likely am I to need to catheterize myself?
- What blood tests will I need, and how often?
- What should I do if I cannot empty the neobladder at night or on a weekend?
- How will my urethra be checked for cancer in the future?
Words you may hear
- Pneumoperitoneum
- The gas-filled belly that makes keyhole surgery possible. Carbon dioxide is pumped in through a thin needle or the first port until the belly wall lifts like a tent (usually at a pressure of 12 to 15 mmHg), giving the camera and instruments room to work. The gas is let out at the end, and the little that remains is absorbed and breathed out over a day or two; it can cause shoulder-tip ache in the meantime.
- Neobladder
- A new bladder made from bowel and joined to the urethra.
- Orthotopic
- In the normal place. An orthotopic neobladder sits where the old bladder was.
- External sphincter
- The ring of muscle around the urethra that keeps you dry.
- Pelvic floor
- The sling of muscles at the bottom of the pelvis that supports the organs and helps control urine.
- Timed voiding
- Emptying on a schedule by the clock, instead of waiting for an urge.
- Straining to void
- Gently tightening the belly muscles, while relaxing the pelvic floor, to push urine out of a neobladder.
- Post-void residual
- The urine left behind after you empty, often measured with a quick ultrasound.
- Clean intermittent self-catheterization
- Passing a thin catheter yourself a few times a day to drain urine, then removing it.
- Mucus
- Slippery material made by the bowel lining, seen as white strands in the urine.
- Metabolic acidosis
- Too much acid in the blood, which can happen when bowel absorbs acid from urine.
- Cystogram
- An X-ray with dye in the neobladder to check for leaks before the catheter is removed.
- Irrigation
- Flushing a catheter or neobladder with sterile salt water to clear mucus.
- Urethral margin
- The cut edge of the urethra, checked for cancer during surgery.
Common questions
Will it feel like my old bladder?
Not quite. Most people do not feel a sharp urge. They feel fullness, pressure or bloating in the lower belly, and empty by the clock.
Can I stand to urinate?
Sitting is best at first because it helps you relax and empty fully. Many men later stand once they empty reliably.
Will the mucus go away?
It lessens over the first year but never completely stops. Drinking plenty of fluids keeps it thin.
Will I be dry at night?
Many people are, but it takes longer than daytime control. An alarm to empty once or twice a night, and emptying before bed, help a great deal.
Can women have a neobladder?
Yes. Women are more likely to have trouble emptying fully and may need to self-catheterize, but many do very well, especially when the nerves and uterus can be spared.
What if it does not work for me?
Most problems, such as leakage or poor emptying, can be improved with exercises, catheterization or smaller procedures. Rarely, a neobladder is converted to a conduit.
Is cancer control as good as with a conduit?
Yes, when you are a good candidate. The cancer operation is the same; only the way urine leaves the body differs.
Sources this page draws on
- American Urological Association, ASCO, ASTRO and Society of Urologic Oncology, Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline
- European Association of Urology, EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer
- International Consultation on Urological Diseases and European Association of Urology, ICUD-EAU International Consultation on Bladder Cancer 2012: Urinary Diversion (Hautmann and colleagues, European Urology) (2013)
- American Cancer Society, Bladder Cancer Surgery
- Urology Care Foundation, Bladder Cancer
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.