Surgery Overview

Cystectomy is the surgical removal of all or part of the bladder. It is used to treat bladder cancer that has spread into the bladder wall or to treat cancer that has come back (recurred) following initial treatment. There are three types of cystectomy:

• Partial cystectomy is the removal of part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area. Partial cystectomy is only a good choice if the cancer is not near the openings where urine enters or leaves the bladder.
• Simple cystectomy is the removal of all of the bladder.
• Radical cystectomy is the removal of the entire bladder, nearby lymph nodes (lymphadenectomy), part of the urethra, and nearby organs that may contain cancer cells.
  • In men, the prostate, the seminal vesicles, and part of the vas deferens are also removed.
  • In women, the cervix, the uterus, the ovaries, the fallopian tubes, and part of the vagina are also removed.

The surgery is done through a cut (incision) the doctor makes in your lower belly. Sometimes it can be done as laparoscopic surgery. Some people call this "Band-Aid surgery," because it requires only small cuts. To do this type of surgery, a doctor puts a lighted tube, or scope, and other surgical tools through small cuts in your lower belly. The doctor is able to see your organs with the scope.

If you have a simple cystectomy or radical cystectomy, your doctor will create a new way to pass urine from your body. There are several ways this can be done.

• An ileal conduit uses a piece of your small intestine to make a tube. The tube connects your ureters to an opening the doctor makes in your belly. Your ureters are the two tubes that normally carry urine from the kidneys to the bladder. After surgery, the urine passes from the ureters through the conduit and out the opening into a plastic bag that is attached to your skin.
• A continent reservoir uses a piece of your bowel to create a storage pouch that is attached inside your pelvis. There are two types. Both types let you control when you urinate. You may have a:
  • Bladder substitution reservoir (neobladder). If your urethra was not removed as part of the surgery, your continent reservoir will attach to your ureters at one end and your urethra at the other. This allows you to pass urine much as you did before surgery.
  • Continent diversion reservoir with stoma (urostomy). If all or part of your urethra was removed during your surgery, your continent reservoir will connect your ureters to an opening the doctor makes in your belly. You will pass a thin plastic tube called a catheter through the opening to release the urine.

What To Expect After Surgery

Cystectomy usually requires a hospital stay of about a week. You can expect some discomfort during the first few days after surgery. This discomfort is usually controllable with home treatment and medicine. Complete recovery usually takes 6 to 8 weeks.

More treatment may be needed following a radical cystectomy and may include radiation therapy or chemotherapy. Immunotherapy may be used after a partial cystectomy for early-stage tumors.

After initial treatment for bladder cancer, it is important to receive follow-up care. Your doctor will set up a regular schedule of checkups and tests.

Why It Is Done

Cystectomy is used to remove and attempt to cure cancer that has invaded the wall of the bladder or has come back (recurred) following initial treatment or has a high chance of spreading.

How Well It Works

Out of 100 people who have a cystectomy for cancer that is in the muscle of the bladder and hasn't spread any farther, 75 are alive after 5 years. If the cancer has spread beyond the muscle to the area outside the bladder (regional spread), only 36 out of 100 people who have a cystectomy are alive after 5 years. For bladder cancer that has spread farther, the survival rate is even less.¹

Risks

Complications are common after a radical cystectomy and may include:^{2, 3}

• Acidosis. This in an imbalance in electrolytes such as calcium and potassium. It can be caused by using a part of the intestine to divert urine after a cystectomy. People with acidosis often need to take medicine to control it.
• Urine leak.
• Infection.
• Fistula formation.
• Bowel obstruction.
• Rectal injury.

What To Think About

Bladder cancer surgery may affect your fertility. If a woman's uterus or ovaries are removed during the surgery, she will not be able to get pregnant. If a man's prostate gland is removed, he will not be able to father a child. If you are concerned about your fertility, talk to your doctor about your options before your surgery.

Bladder cancer surgery may also affect how you feel about your body. It may also affect your sexual function. Having sexual intercourse may be more difficult for a woman who has part of her vagina removed. A man may have erection problems if his surgery involves removing the prostate and seminal vesicles. For more information, see the topic Sexual Problems in Women or Erection Problems.

If a woman's ovaries are removed during the surgery, she may have hot flashes and other symptoms of menopause. For more information, see the topic Menopause.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

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