Cystectomy

A cystectomy is a surgical procedure that removes all or part of your bladder. It is usually part of the treatment plan for bladder cancer. For most cancer patients, this surgery is performed after chemotherapy.

Types of cystectomy

The two main types of cystectomy are defined by how much of the bladder is removed.

With a radical cystectomy, your surgeon removes the bladder completely, along with nearby lymph nodes. Lymph nodes are small glands throughout your body that may also have cancer cells. With a radical cystectomy, certain pelvic organs also are excised. For men, this includes the prostate and seminal vesicles (two glands that are part of the male pelvis). For women, the cervix, fallopian tubes, ovaries, uterus and a small part of the vagina are removed as well. This is done to try to eliminate all cancer cells. As part of the surgery, your care team creates another way to pass urine based on the most appropriate option for you. This may be through a new bladder, also called a neobladder, created with a section of intestine, or through urinary diversion, which creates a new route for urine from your body. Without a bladder, urine passes through a permanent opening created on the abdomen (a stoma) and either into a pouch that needs to be regularly emptied or in an internal pouch that you’ll empty with a catheter. Sometimes when the cancer has spread and can’t be contained, surgery to remove only the bladder is done to relieve a blockage that prevents the flow of urine.

With a partial cystectomy, the surgeon removes only the part of the bladder affected by cancer. Sometimes, a part of the bladder wall also is removed. A partial cystectomy allows you to keep your bladder and avoid surgery to create another pathway for urine to leave the body. However, the bladder that remains will likely not hold the same amount of urine as before, causing the need to use the bathroom more often.

This surgery can be complex. Make sure that you’re working with a skilled and experienced surgeon.

How to prepare for a cystectomy

There are a few steps you can follow in advance of your cystectomy to be better prepared for surgery:

• Ask your care team what type of physical activity you should perform in the weeks leading up to your surgery. Staying physically active, such as walking every day, can help improve your surgical results.
• Don’t smoke. Besides being a risk factor for bladder cancer, smoking can negatively affect the outcome of surgery.
• Follow any advice from your care team regarding eating or drinking the day before and the day of your surgery. For example, you may be told to have only clear liquids the day before surgery. You may also need a bowel prep to clean out your intestines.
• If you’re undergoing a radical cystectomy, ask any questions about how this will change how you pass urine. For instance, with a neobladder, you no longer have the feeling of needing to urinate, so you must learn how to urinate on a schedule.
• Discuss any sexual side effects you could potentially experience after surgery.

What to expect from a cystectomy

Before the procedure starts, you’ll be given anesthesia to put you in a sleep-like state.

Many surgeons now perform a laparoscopic cystectomy, with or without robotics to assist. Using special tools, this procedure allows for small incisions on the abdomen and a quicker recovery time, as compared with traditional or “open” surgery. With a radical cystectomy, your surgeon will create a way for urine to pass out of your body.

You typically will stay in the hospital for a few days to recover from a laparoscopic cystectomy and up to a week after traditional surgery. Expect to experience some pain as you heal. You’ll be given medication to help ease the discomfort.

Benefits and risks of a cystectomy

The major benefit of a cystectomy is to remove bladder cancer. One risk of having only a partial cystectomy is that the cancer may return.

As with any surgery, there also are general risks, such as:

• Blood clots
• Infection
• Injury to nearby organs

It may take time to adjust to living without a bladder after a radical cystectomy. You may experience:

• Leaking of urine
• Difficulty sensing when to urinate with a neobladder
• Erectile dysfunction
• Loss of sexual sensations

Ask your surgeon about nerve-sparing procedures to help preserve sexual sensations.

Reviewing the results of a cystectomy

It may take about a week to get pathology results after a cystectomy. These can help determine what other treatments you may need.

These may include:

• Additional chemotherapy to get rid of remaining cancer cells
• Adjuvant therapy, which is treatment to help lower the chance of cancer returning