Which of the following is a documented disadvantage of neobladder?

• A. Possible nocturnal leakage
• B. Immediate independence from catheterization
• C. No risk of pouchitis
• D. Urine will not be bloody post-op

Answer: (A)

The key idea here is that an orthotopic neobladder can provide good daytime continence but often comes with nighttime incontinence as a documented drawback. A neobladder is built from a segment of intestine and connected to the urethra to function as a bladder substitute. While many patients achieve control during the day, at night the reservoir’s capacity, sensation, and outlet control may not match a native bladder. This can lead to nocturnal leakage, which is a recognized issue that can affect sleep quality and may require strategies such as timed voiding, pelvic floor exercises, or intermittent catheterization if there’s incomplete emptying.

The other statements describe outcomes that are not disadvantages: independence from catheterization would be an advantage; saying there is no risk of pouchitis overstates the safety of using intestinal tissue for a neobladder, since complications related to the intestinal segment can occur; and expecting no blood in urine post-op is not accurate since some hematuria is common during the healing period.