In an orthotopic neobladder, what happens to the native bladder?

• A. It remains in place and is preserved
• B. It is removed or bypassed
• C. It continues to drain through the urethra separately
• D. It is replaced with a prosthetic bladder

Answer: (B)

In an orthotopic neobladder the goal is to create a new urine reservoir from bowel tissue that stores urine and can be emptied through the urethra, mimicking natural voiding. To make this work reliably, the native bladder is removed or bypassed so that all urine goes into the neobladder. Keeping the native bladder in place would create a second, nonfunctional reservoir that can trap urine, increase infection risk, and complicate continence, without contributing to drainage. By removing or bypassing the native bladder, there’s a single, controllable reservoir—the neobladder—from which urine is emptied via the urethra.