Neobladder or Indiana Pouch

I may have the option for the neobladder. At first, my impression was that this is "the way" to go, the most natural, etc. Then I started reading about incontinence, and worse, hypercontinence which would mean catheterizing oneself (vaginally). I'm not sure I want to deal with that .Can anyone(female please) tell me just how difficult catheterizing oneself is. I just may choose the Indiana pouch because of this. Also, after complete recovery, how long does it take to drain pouch on average. A simple list of pros and cons neobladder vs Ind Pouch as far as post surgery care goes would be helpful Thankyou

Edited July 4, 2009 at 10:18 pm

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Jul, I have an Indiana Pouch (Jan'04). It is very easy to cath (essentially no feeling to the stoma). The learning curve for each of us depends on where we start, how much we understand, if we have any complications after surgery, and etc. When the Dr. instructs you to begin self cathing the stoma, usually two or more weeks post surgery(the new bladder must heal before allowing it to fill with urine) you will learn to recognize the full tummy feel as a signal you need to empty, although at first, you will be on a two hour schedule to empty. I visualize the bladder as a balloon that collapses as it empties, so I move the catheter around to catch pockets that might have urine that needs to drain. You will soon learn your own technique and time frame. It is necessary to drink lots of fluids and to flush the bladder (with saline water) to remove the natural mucus that accumulates (being intestine, it produces mucus).
I believe some women have weak pelvic and abdominal muscles that hinder good technique in the neobladder type of diversion. Those who have the neobladder will reply to you, I'm sure. I suspect some women have issues from having children that may play a part in how well they can learn to efficiently use their muscles to void the neobladder.
My urethra had to be removed, so I couldn't have the neobladder. I can't relate how I would have done with that diversion. I can say I am happy with my Indiana Pouch.
It is imperative you have a surgeon who has done many of these diversions on women. We do present different problems from the men.
Whatever you choose, you will be happy to be cancer free and you will learn how to work with it.
Karego

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I am a man who has an Indiana pouch. I know a woman whose neo-bladder stopped working after a year. Now she has to catheterize herself to void urine. Women tend to experience more problems with the neo-bladder than men do.

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I have the illeal conduit so I can't speak for either the neo or IP but I have read that many women do experience problems with the neo. However, Anna on this site has a neo and has done very well. The neo is a bigger problem for women than for men.
Nancy

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Not female, but have had a neobladder for about 16 months. As you have probably discovered continence issues are a slightly bigger problem for women than men. Training the neobladder is similar to what Karen described for the Indiana pouch. The reservoir starts out as a lower volume higher pressure entity than will allow continence, so that the time between voiding is gradually increased to about 4 hours. A very high percentage of patients achieve daytime continence, but night time continence is somewhat less. I have been lucky and am in the continent group for both time frames and have never had to cath. With both the I pouch and the neo the diversion must be emptied by the clock, about every 4 hours, depending on the rate of urine production. When these diversions become overstretched, there is a higher risk for complications. Although I have no regrets regarding my diversion, I believe that one becomes accustomed to the diversion that they have and the vast majority are satisfied. None of the diversions seems to be a limiting factor in terms of life style. There are many active people with all types engaging in all levels of activity. To me the biggest advantage of an ileal conduit is that one can sleep through the night, uninterrupted. Best wishes,

JJ

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Thankyou so much for your response. I probably will go with the Indiana pouch, there is a chance I may not be able to have the neobladder anyway (which we won't know till surgery). Your response was very helpful, thanks again JUL

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Hi

I have a neobladder and Í am doing very well however I was not a typical bladder cancer patient before my surgery.
I am only 42 years old I am\was physicically fit and slender before my surgery. It requires a certain amount of abdominal strenght to empty the neo and I think its easier to maintain continence when one is more slender, I have had some accidents while running but nothing major (you add 9 times your body weight while running on your joints and I imagine on ones bladder as well).
I achieved night time and day time continence almost immediately and my main problem is that if I go to long without voiding (or if I have been drinking too much) my kidneys starts to hurt, I believe its due to reflux since the backflush valves on the urethers were removed during the surgery.

I feel normal and I have have been wearing a bikini this summer....I'm not hiding anything ..I'm proud of who I am and what my body has been through. (but the scar is really not that significant either)

I think you have to look at all the pieces of the puzzle and see what diversion that fits you the best, there are pros and cons to all diversions.

Good luck!!!

Anna

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I had neo bladder at Sloan Kettering July 04 and am doing great. I find self cath to be very easy. I have to do it daily. Sloan is trying a new way of holding up neobladder to help this issue. I do not know success of it.

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Here is a link where you can read about both the Neobladder and the IP. CrazYhorse

http://blcwebcafe.org/content/view/127/137/lang,english/

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I have a neobladder and have always had to self cath. Once I got my head around it - it really is not a problem. I would rather cath than be incontinent.

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