ABSTRACT
A natural progression of the continent cutaneous urinary diversion was the orthotopic bladder substitute (neobladder) connected directly to the native intact urethra. The orthotopic neobladder resembles the original bladder in location and function. An orthotopic form of reconstruction eliminates the need for a cutaneous stoma and a cutaneous collection device and relies on the patients’ intact rhabdosphincter continence mechanism (external striated sphincter muscle); eliminating the need for intermittent catheterization in most cases and the efferent limb of the continent cutaneous reservoir which may require revisional surgery. Voiding is effectively accomplished by concomitantly increasing intra-abdominal pressure (Valsalva) with relaxation of the pelvic floor musculature.
