Bladder Removal Surgery Procedure
Overview
Cystectomy is a procedure that removes the urinary bladder. There are different types of this surgery:
- Radical Cystectomy: The surgeon removes the entire bladder. For men, the prostate and seminal vesicles may also be removed. For women, the uterus, ovaries, fallopian tubes, and a part of the vagina can be included.
- Partial Cystectomy: The surgeon removes only part of the bladder, usually if the tumor is in one specific area.
- Simple Cystectomy: The surgeon removes the bladder without removing other organs and usually performs this for non-cancerous conditions.
- Robotic cystectomy and open cystectomy are ways to perform the surgery. Robotic uses small incisions and special tools, while open cystectomy uses a larger cut.
After removing the bladder, the surgeon creates a new path for urine, called urinary diversion. The team chooses the right diversion method based on each person’s needs.
Reasons for Bladder Removal Surgery
Doctors usually recommend bladder removal surgery for people with bladder cancer, especially when the cancer is muscle-invasive or has spread into the bladder wall. This procedure may treat both non-muscle invasive and muscle-invasive bladder cancer, depending on how the cancer responds to other treatments.
Other reasons include birth defects in the urinary system, long-term inflammatory or neurological conditions, and serious damage to the bladder from earlier cancer treatments or radiation. Urologic oncologists help patients choose the best treatment plan for their needs.
Common Reasons for Surgery:
- Muscle-invasive or invasive bladder cancer.
- Non-muscle invasive bladder cancer resistant to other treatments.
- Severe urinary system damage from disease or previous cancer therapy.
- Chronic neurological problems affecting bladder function.
Possible Complications
Cystectomy and related treatments such as TUR (transurethral resection), TURBT, chemotherapy, immunotherapy, targeted therapy, radiation therapy, and intravesical therapy can cause several risks. Some of the most common problems include:
- Bleeding
- Blood clots
- Infections
- Poor healing at the surgery site
- Injury to nearby organs or tissues
- Sepsis (a severe infection reaction in the body)
- Possible death due to severe complications (rare)
Complications from urinary diversion or other treatments can include:
| Problem | Description |
|---|---|
| Diarrhea | Ongoing loose stools |
| Kidney function drop | Kidneys not working as well |
| Mineral imbalance | Abnormal levels of body minerals |
| Low vitamin B-12 | Not enough vitamin B-12 in the body |
| Urinary tract infections | Repeated infections in the urinary system |
| Kidney stones | Hard deposits that form in the kidneys |
| Urinary incontinence | Loss of bladder control |
| Bowel obstruction | Blockage in the intestines |
| Ureter blockage | Blocked urine flow from kidneys |
Some side effects may require hospital care or another surgery. The healthcare team explains what to watch for during recovery.
Steps to Get Ready
Patients should meet with their surgical team before bladder surgery. During these visits, the team reviews a full list of current medicines, vitamins, and any herbal supplements the patient takes. The team also asks about alcohol, caffeine use, and any recreational drug habits.
Smokers should talk with a member of the care team about ways to stop smoking, as it can slow healing and may lead to problems with anesthesia. Surgeons generally require a clear liquid diet for one or two days before surgery. Water, broth, and clear juices are allowed, but patients should avoid all solid food.
Most patients need to stop eating and drinking after midnight the night before the operation. The healthcare team gives instructions on whether to continue or stop daily medicines such as blood thinners, diabetes medicines, or certain herbal supplements. A simple checklist before bladder surgery:
- Review all current prescriptions and supplements with your health team.
- Arrange help for after surgery.
- Finish any pre-op lab work or tests.
- Follow all food and drink instructions from your doctor.
| Item | Must Do Before Surgery? |
|---|---|
| Clear liquid diet | ✔ |
| Stop eating after midnight | ✔ |
| Tell the team about all medicines | ✔ |
| Plan for help after hospital | ✔ |
Learning About Urine Pathway Changes After Surgery
After the surgeon removes the bladder, the body needs a new way to store and pass urine. Several options exist, called urinary diversions.
- Neobladder: The surgeon makes a new bladder from part of the intestine. Many people can urinate much like before, using pelvic muscles.
- Ileal Conduit: The surgeon uses a piece of intestine to create a passageway (conduit) for urine to exit the body through a stoma. Urine drains outside the body into a urostomy bag.
- Continent Urinary Diversion: The surgeon forms an internal pouch from the intestine, creating a small reservoir. The patient drains urine with a catheter through a small opening on the belly.
Types of urinary diversion:
| Diversion Type | Method | Uses Bag? |
|---|---|---|
| Orthotopic neobladder | Internal pouch, uses urethra | No |
| Ileal conduit | Tube to stoma, uses external urostomy bag | Yes |
| Continent diversion | Internal pouch, drained with a catheter | No* |
*Needs catheter, but no external bag
The medical team — including urologists, medical oncologists, radiation oncologists, and others — explains choices like neobladders or ileal conduits. They also provide training on how to use and care for equipment, such as stoma care or urostomy bags. For some people, a genetic counseling consult may be part of planning. This support helps patients feel ready to look after themselves after surgery.
What You Might Experience
What Happens in the Operating Room
The anesthesiologist gives anesthesia to help the person sleep and relax. The patient does not stay awake or feel pain during the procedure. Surgeons can use open surgery, minimally invasive surgery, or robotic methods. Open surgery requires one large cut on the abdomen, while minimally invasive techniques use several small openings for special tools.
The surgeon removes the bladder and, depending on the condition, may also take out nearby lymph nodes to check for cancer spread. Sometimes, the surgeon removes other organs as well, depending on the reason for surgery. After removing the bladder, the surgeon creates a new way for urine to leave the body, called a urinary diversion. There are three main types:
Urinary Diversion Types
| Diversion | Catheter Use | Incontinence Risk |
|---|---|---|
| Ileal Conduit | Not usually needed | Bag may leak if not secure |
| Continent Reservoir | Needed | Less risk if used correctly |
| Neobladder | Sometimes needed | Possible, especially at night |
No matter which method the team chooses, they plan the process to fit the patient’s needs.
What To Expect in Hospital and at Home
After the operation, a person may feel tired, have a dry mouth, or feel cold and sleepy. Some people experience sore throat, nausea, or vomiting. The medical team monitors vital signs and gives medicine for comfort when needed. Once awake, patients are usually encouraged to get up and move, even starting the day after surgery.
Walking helps blood flow, prevents stiff joints, and gets the bowels working again. Recovery may be slower if the stomach and bowel take time to start working. Depending on the type of surgery, the hospital stay usually lasts 5 to 14 days, with open surgery needing more time than minimally invasive approaches. Before leaving the hospital, the nurse or doctor gives written directions for caring for any cuts and wounds.
These instructions include what to watch for, such as swelling, redness, or leaks. The team discusses proper cleaning of wounds and care of urinary diversion systems, such as pouches or catheters, in detail before the patient goes home. The goal is for each patient to feel comfortable managing their new system to avoid infections or leaks.
Possible Devices and Supplies After Surgery
- Stoma bags for collecting urine when an ileal conduit is in place.
- Catheters for draining a continent reservoir or sometimes a neobladder.
- Wound dressings for incisions or stomas.
- Special cleaning solutions for hygiene and care.
Some people may have trouble controlling urine (incontinence) with certain types of diversions. This can be more common, for example, at night with a neobladder, or if the pouch overfills. Nurses teach patients how to manage these problems for a smoother adjustment.
Checking In With the Care Team
Once home, patients need regular check-ups. The first clinic visit usually takes place a few weeks after leaving the hospital, with follow-ups at regular intervals in the coming months. The healthcare team checks how well urine flows through the new system and makes sure the body’s salt and water balance (electrolytes) is normal.
If the team removed the bladder because of cancer, they use these visits to look for signs the cancer might have returned. Even if cancer was not the reason, these visits ensure the new urinary system works safely and that possible problems are found early.
Topics Discussed at Follow-Ups
- How the urinary diversion is working.
- Using and cleaning stoma equipment or catheters.
- Managing leaks or incontinence.
- Checking surgical wounds.
- Addressing any questions from the patient or family.
Appointments continue for many years after surgery—sometimes for the rest of life. Staying in touch with the care team helps catch any problems early and offers a chance to adjust supplies or routines.
Getting Back to Normal Life
Healing and returning to regular routines takes time. Most people should avoid heavy lifting, driving, or returning to work for at least six weeks after surgery. Activities like bathing or taking showers are usually safe soon after the operation, based on the doctor’s advice.
Returning to school, work, or sports should be gradual. People may get tired more easily or need to manage their stoma or catheter during the day. Planning for breaks or finding private places to care for a diversion system will help ease the process. Below are common steps for returning to activities:
- First Weeks
- Rest as much as possible.
- Avoid heavy objects or exercises.
- Take short daily walks to build strength.
- After Six Weeks
- Ask the healthcare team before increasing activities.
- Start light chores and, if feeling strong, return to work or school.
- Reintroduce hobbies as comfort allows.
- Ongoing
- Keep supplies like pouches or catheters handy.
- Watch for leaks or soreness.
- Talk to nurses or doctors if there are problems with incontinence or pain.
With practice, most people adjust to their new routines.
Passing Urine
After bladder removal and reconstructive surgery, many patients notice changes in how they urinate. For those who received a neobladder, the new bladder functions similarly to the original bladder, but gaining full control often takes time. At first, it is common to experience urinary leakage, which usually improves as the neobladder gets larger and the surrounding muscles get stronger.
Patients are encouraged to urinate on a schedule to help the new bladder work well. Some might need to use a catheter to fully empty the bladder, which can become a regular part of daily life. When the surgeon creates a stoma as part of bladder reconstruction, patients need to care for it properly.
This may require emptying a urine collection bag several times a day or using a catheter to remove urine from the stoma. Proper stoma care helps reduce risks like infections or skin irritation. Medical teams support patients and provide resources for self-care and device management.
| Adjustment | Description |
|---|---|
| Scheduled voiding | Helps train the neobladder or reconstructed bladder |
| Catheter use | Sometimes needed to fully empty the bladder |
| Stoma care | Important for those with an external urine pouch |
Intimate Life
Bladder reconstruction surgery and urinary diversion can bring about lasting changes in sexual health for both males and females. For women, tissue removal during surgery can make intimacy feel different, sometimes causing discomfort or reducing arousal. Nerve changes can make reaching orgasm more difficult.
Men may also experience sexual side effects. Surgery can damage nerves responsible for erections, and removing parts like the prostate or seminal vesicles eliminates ejaculation. Even so, some men still feel pleasure and reach orgasm, but no fluid is released. People often feel self-conscious because of a stoma or urinary pouch. To help with comfort:
- Empty the pouch before intimate activity to lower leak risks.
- Use a cover or band to keep the pouch secure.
- Try new positions or activities to find what feels best.
Sexual health specialists can provide personalized advice. Support groups and counseling help address concerns and improve confidence after surgery.
