What does the term 'orthotopic' mean in relation to a neobladder?

• A. Orthotopic means new bladder
• B. Orthotopic means in the same place
• C. Orthotopic means around the bladder
• D. Orthotopic means outside the body

Answer: (B)

Orthotopic refers to placing the bladder substitute in the same pelvis location as the original bladder, with the outlet connected to the urethra so urine can be voided through the natural channel. In a neobladder, this means the reconstructed reservoir sits in the pelvis where the bladder used to be and is designed to drain via the urethra, aiming for a more normal urinary pathway. This contrasts with other diversions, like an ileal conduit, where urine exits through a stoma on the abdominal wall into an external bag, which is not in the original bladder’s place. With an orthotopic neobladder, patients often achieve continence and natural voiding, though training and individual function vary.