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(Radical Bladder Removal, Partial Bladder Removal)

Definition

A cystectomy is surgery to remove all or part of the bladder. There are 2 types:

  • Partial: removes part of the bladder
  • Radical: removes all of the bladder, nearby lymph nodes, and part of the tube that carries urine out of the bladder

Reasons for Procedure

This surgery may be done to treat:

  • Bladder cancer
  • Problems with nerve-muscle control of the bladder
  • Bladder problems or bleeding from things like radiation, chemotherapy, or injuries
  • Severe interstitial cystitis (rare)

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Excess bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Infection
  • Blood clots
  • Loss of sexual function
  • Fluid build-up in the belly
  • Harm to other organs
  • Blockage of urine flow
  • Loss of urine control

Things that may raise the risk of problems are:

  • Prior abdominal or pelvic surgery
  • Prior radiation therapy
  • Smoking
  • Drinking
  • Chronic diseases, such as diabetes or obesity

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Whether you need a ride to and from surgery

Anesthesia

The doctor will give general anesthesia. You will be asleep.

Description of Procedure

There are 2 different methods:

Open Surgery

An incision will be made in the belly. In a partial cystectomy, only part of the bladder will be removed. In a radical cystectomy, all blood vessels to the bladder will be cut. The bladder will be removed. The doctor may also remove nearby lymph nodes, part of the tube that carries urine from the bladder, and any nearby organs. In men, these organs are the prostate and glands that help make semen. In women, they are the uterus, ovaries, and vagina.

The doctor will make a new way for urine to leave the body. A new bladder may be built. This can be done using pieces of intestine. Or, an external bag may be attached to the belly ( urostomy). The incision will be closed with stitches. A bandage will be placed over the area.

Laparoscopic Surgery

Small incisions will be made in the belly. A scope with a small camera on the end will be passed through one of the incisions. The camera will display the area on a video screen. Robotic arms holding tools may be inserted through the holes. In a partial cystectomy, only part of the bladder will be removed. In a radical cystectomy, all blood vessels to the bladder will be cut. The bladder will be removed. The doctor may also remove nearby lymph nodes, part of the tube that carries urine from the bladder, and any nearby organs. In men, these organs are the prostate and glands that help make semen. In women, they are the uterus, ovaries, and vagina.

The doctor will make a new way for urine to leave the body. A new bladder may be built. This can be done using pieces of intestine. Or, an external bag may be attached to the belly ( urostomy). The incisions will be closed with stitches. A bandage will be placed over the incisions.

Kidneys, Ureters, and Bladder
The Urinary System
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How Long Will It Take?

About 3 to 6 hours

Will It Hurt?

Pain and swelling are common in the first 1 to 2 weeks. Medicine and home care can help.

Average Hospital Stay

The usual length of stay is 5 to 12 days. If you have any problems, you may need to stay longer.

Post-procedure Care

At the Hospital

Right after the procedure, the staff may:

  • Give you pain medicine
  • Ask you to get up and walk to improve bowel function and blood flow
  • Teach you how to drain urine if a urostomy was done

During your stay, staff will take steps to lower your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to lower your chance of infection, such as:

  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Not allowing others to touch your incisions
At Home

It will take 4 to 6 weeks to recover. Physical activity may need to be limited during this time. You may need to ask for help with daily activities and delay return to work.

Call Your Doctor

Call your doctor if you are not getting better or you have:

  • Signs of infection, such as fever and chills
  • Redness, swelling, heavy bleeding, or leaking from the incisions
  • Nausea and vomiting
  • Pain that you cannot control with medicine
  • Problems urinating, cloudiness or pus in the urine, or a bad odor to the urine

If you think you have an emergency, call for medical help right away.

RESOURCES

National Institute of Diabetes and Digestive and Kidney Diseases  http://www.niddk.nih.gov 

Urology Care Foundation  http://www.urologyhealth.org 

CANADIAN RESOURCES

Canadian Urological Association  http://www.cua.org 

Public Health Agency of Canada  http://www.phac-aspc.gc.ca 

References

Bellmunt J, Orsola A, et al; ESMO Guidelines Working Group. Bladder cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol 2014 Sep;25 Suppl 3:iii40.

Bladder cancer diagnosis and staging. EBSCO DynaMed website. Available at: https://www.dynamed.com/evaluation/bladder-cancer-diagnosis-and-staging. Accessed October 15, 2020.

Bladder cancer treatments. Bladder Cancer Advocacy Network website. Available at: https://bcan.org/bladder-cancer-treatment. Accessed October 15, 2020.

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