Ileal loop (ileal conduit) and orthotopic ileal neobladder operations are surgical procedures performed following bladder removal, typically due to bladder cancer. These procedures create new pathways for urine to exit the body. Here i will answers to common questions about the procedures, their benefits, and potential complications to help patients understand what to expect and how to manage their postoperative care.

FAQs about ileal loop and orthothopic ileal neobladder operations

Ileal loop and artificial bladder (ileal neobladder) surgeries are frequently performed after cystectomy in patients with advanced bladder cancer. Commonly asked questions and answers regarding these surgeries are summarized below.

What is an Ileal Loop?

An ileal loop, also known as an ileal conduit, is a surgical procedure used to divert urine after the bladder has been removed. A small piece of the small intestine (ileum) is used to create a passageway for urine to exit the body. The urine is then collected in an external bag attached to the abdomen.

What is an Orthotopic Ileal Neobladder?

An orthotopic ileal neobladder is a type of urinary reconstruction where a new bladder (neobladder) is created from a segment of the ileum. This new bladder is connected to the urethra, allowing patients to void urine in a manner similar to natural urination.

Why are these surgeries performed?

Both ileal loop and orthotopic ileal neobladder surgeries are typically performed after a cystectomy, which is the removal of the bladder due to conditions like bladder cancer. These procedures provide alternative ways for urine to be stored and eliminated from the body.

How is urine managed after an ileal loop operation?

After an ileal loop operation, urine is collected in an external ostomy bag attached to a stoma (an opening on the abdomen). The bag needs to be emptied and changed regularly.

How is urine managed after an orthotopic ileal neobladder operation?

After an orthotopic ileal neobladder operation, urine is passed through the urethra. Patientsmay need to use techniques like abdominal pressure or intermittent self-catheteization to fully empty the neobladde

What are the benefits and drawbacks of each procedure?

• Ileal Loop
  • Benefits: Simpler surgery, fewer complications.
  • Drawbacks: External bag required, potential for skin irritation and infections.
• Orthotopic Ileal Neobladder:
  • Benefits: More natural urination, no external bag.
  • Drawbacks: More complex surgery, potential for urinary incontinence and need for self-catheterization.

What are the potential complications of an ileal loop?

Potential complications include skin irritation around the stoma, urinary infections, and the need for regular maintenance of the external bag.

What are the potential complications of an orthotopic ileal neobladder?

Potential complications include urinary incontinence, difficulty emptying the neobladder completely, and the possibility of needing intermittent catheterization.

What is the recovery like after these surgeries?

Recovery involves hospital stay, pain management, learning to manage urine output, and gradual return to normal activities. Follow-up care is essential to monitor for complications and ensure proper function of the urinary diversion.

What lifestyle changes might be necessary?

Patients may need to adjust their diet, fluid intake, and activities to manage their new urinary system effectively. Regular follow-up with healthcare providers is important to monitor health and address any issues promptly.

These surgeries provide life-altering solutions for patients needing bladder removal, each with unique considerations and lifestyle adaptations.

How long is the recovery period after these surgeries?

Recovery typically involves a hospital stay of several days to a few weeks, followed by several months of gradual recovery. Patients need to adapt to the new way of urine management and may require physical therapy or rehabilitation.

What lifestyle changes might be necessary after these surgeries?

Patients may need to adjust their fluid intake, diet, and activities to manage their new urinary system effectively. Regular follow-up care is essential to monitor for any complications and ensure the proper function of the urinary diversion.

Can normal activities be resumed after these surgeries?

Yes, most patients can return to normal activities, including work and exercise, after a recovery period. However, they will need to learn how to manage their new urinary system and make necessary adjustments to their lifestyle.

Is erectile dysfunction occur after Ileal Loop and Orthotopic Ileal Neobladder Operations?

Erectile dysfunction (ED) can occur after both ileal loop (ileal conduit) and orthotopic ileal neobladder operations. In both surgery nerve damage, impaired blood suppley to penis and psychologic factors are responsible from erectile dysfunction.

How is the management of erectile dysfunction post-surgery?

Management of ED after these operation is as follows:

Pharmacological Treatments:

1. Phosphodiesterase-5 Inhibitors: Medications like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) can help improve erectile function by increasing blood flow to the penis.

Mechanical Devices:

1. Vacuum Erection Devices (VEDs): These devices can help achieve and maintain an erection by creating a vacuum around the penis, drawing blood into the erectile tissues.

Surgical Options:

1. Penile Implants: For those who do not respond to other treatments, surgical insertion of a penile implant can be an effective solution.

Psychological Support:

1. Counseling and Therapy: Addressing the psychological impacts of surgery, body image changes, and sexual function through counseling can be beneficial.

Pelvic Floor Rehabilitation:

1. Physical Therapy: Exercises to strengthen the pelvic floor muscles can help improve sexual function.

Summary

Ileal loop and orthotopic ileal neobladder operations are common urinary diversion techniques following bladder removal. The ileal loop involves creating a stoma for urine to exit through the abdomen, while the neobladder allows for more natural urination. This FAQ addresses key concerns such as procedure details, benefits, potential complications, and postoperative care to help patients understand and manage their recovery.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE