Cystectomy (sis-TEK-tuh-me) is a surgery to remove the urinary bladder.
The procedure to remove the entire bladder is called a radical cystectomy. In men, this typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy usually includes removal of the uterus, ovaries, fallopian tubes and part of the vagina.
After removing your bladder, your surgeon also needs to create a new way to store urine and have it leave your body. This is called urinary diversion. Your surgeon will discuss the options for urinary diversion that may be appropriate for you.
A radical cystectomy is performed to treat cancer that has invaded muscle tissue of the bladder or recurrent noninvasive bladder cancer. A partial cystectomy, although rarely performed, is used to remove a cancerous tumor in an isolated portion of the bladder. A simple cystectomy — removal of only the bladder — may be a treatment for noncancerous (benign) conditions.
Why it's done
Your health care provider may recommend cystectomy to treat:
- Cancer that begins in or spreads to the bladder
- Irregularities in the urinary system present at birth
- Neurological or inflammatory disorders that affect the urinary system
What type of cystectomy and reconstruction you have depends on many things, such as the reason for surgery, your overall health, and your preferences and care needs.
Cystectomy is a complex surgery. It involves the manipulation of many internal organs in your abdomen. Because of this, cystectomy carries with it certain risks, including:
- Blood clots in the legs
- Blood clots that travel to the lungs or heart
- Poor wound healing
- Damage to nearby organs or tissues
- Organ damage due to the body's overreaction to infection (sepsis)
- Rarely, death related to complications from surgery
Other risks associated with urinary diversion vary depending on the procedure, but complications may include:
- Decline in kidney function
- Imbalance in essential minerals
- Vitamin B-12 deficiency
- Urinary tract infection
- Kidney stones
- Loss of bladder control (urinary incontinence)
- A blockage that keeps food or liquid from passing through your intestines (bowel obstruction)
- A blockage in one of the tubes that carries urine from the kidneys (ureter blockage)
Some complications may be life-threatening or require hospitalization. You may need another surgery to correct problems. Your surgical team will provide you with information about when to call your care team or when to go the emergency room during your recovery.
How you prepare
Before your cystectomy, you will talk to your surgeon, your anesthesiologist and other members of the care team about your health and any factors that may affect the surgery. These factors may include:
- Long-term medical conditions
- Drug allergies
- Previous reactions to anesthesia
- Obstructive sleep apnea
You should also review with the surgical team your use of the following:
- Prescription and nonprescription drugs
- Vitamins, herbal medicines or other dietary supplements
- Recreational drugs
- Caffeinated beverages
If you smoke, talk to your health care provider about what help you may need to quit. Smoking can affect your recovery from anesthesia and surgery.
Diet and medications before surgery
Your surgeon may ask you to have a clear liquid diet for 1 to 2 days before surgery. You'll likely need to stop eating and drinking after midnight on the night before your procedure. You'll receive instructions on what medications you should not take in the days before surgery.
Urinary diversion procedure
Your surgical team will talk with you about the type of urinary diversion you'll have. With urinary diversion, you have a new way for urine to be stored and exit the body after the bladder is removed. The goals of urinary diversion are to allow the safe storage and timely elimination of urine. Your doctors also will want to preserve your quality of life as best as possible.
Different kinds of urinary diversion may require different devices. These may include tubes or urine collecting bags. These devices need to be used and cleaned correctly. A nurse or other member of your care team will train you on how to use and care for these devices. This will help you or a care provider be prepared to take on this role after your surgery.
What you can expect
Options for cystectomy surgery include:
- Open surgery. This approach uses a single incision on your abdomen to access the pelvis and bladder.
- Minimally invasive surgery. With minimally invasive surgery, the surgeon makes several small incisions in the abdomen where special surgical tools are inserted to access the abdominal cavity. This type of surgery is also called laparoscopic surgery.
- Robotic surgery. Robotic surgery is a type of minimally invasive surgery. The surgeon sits at a console and remotely operates robotic surgical tools.
During the procedure
You're given a medicine (general anesthetic) that keeps you asleep during surgery. Once you're asleep, your surgeon cuts into your abdomen — one larger incision for open surgery or several smaller incisions for minimally invasive or robotic surgery.
Your surgeon removes the bladder from surrounding tissues. If the treatment is for bladder cancer, the surgeon will also remove nearby lymph nodes, which are part of the immune system. These will be looked at in a lab to see if cancer has spread to them.
In men, a radical cystectomy includes removal of the prostate and seminal vesicles. In women, it includes removal of the uterus, ovaries, fallopian tubes and part of the vagina. How much of the urethra is preserved depends on the type urinary diversion the surgeon will create.
After your bladder is removed, your surgeon creates a urinary diversion — a new system for removing urine. Options include:
- Ileal conduit. The surgeon uses a piece of the small intestine to create a tube (conduit). The ureters previously connected to the bladder are connected to the conduit. Urine drains into the conduit, passes outside the body through a hole in the wall of the abdomen (stoma) and fills a pouch worn under clothes. Urine continually collects in the pouch, which needs be drained frequently and regularly replaced.
- Continent urinary reservoir. During this procedure, the surgeon uses a piece of the intestines to create a pouch (reservoir) inside the abdomen. Like the ileal conduit, the reservoir is connected to ureters and a stoma in the abdominal wall. The reservoir, however, stores the urine. To drain it, you insert a thin tube (catheter) into the stoma.
- Neobladder reconstruction. The surgeon uses a portion of the intestines and reshapes the tissues into a spherical bladder. It is placed in the same location as the original bladder and attached to the ureters and urethra. The neobladder allows you to urinate much as you had with your original bladder. You may need to use a catheter inserted into your urethra to completely drain the new bladder.
After the procedure
After general anesthesia, you may have side effects such as sort throat, shivering, sleepiness, dry mouth, nausea and vomiting. You may receive medications to lessen symptoms.
Starting the morning after surgery, your health care team may have you get up and walk often. Walking promotes healing and the return of bowel function, improves your circulation, and helps prevent joint stiffness and blood clots.
The slow return of typical bowel function is a frequent delay to recovery after a radical cystectomy. If you have an open procedure, you'll likely be in the hospital for 5 to 7 days. With a minimally invasive procedure, your recovery time in the hospital may be shorter.
Before you leave the hospital, a nurse or other health care provider will give you written instructions about wound care and guidelines for when to call your care team or get urgent care. Depending on what type of urinary diversion procedure was performed, you'll also have instructions about care, cleaning and use of devices.
You'll likely return to the clinic for follow-up care in the first few weeks after the cystectomy and again after a few months. At these appointments, your doctor will check to make sure that your upper urinary tract drains adequately and that you don't have electrolyte imbalances.
You'll have a lifelong schedule of regular follow-up appointments to monitor the function of the neobladder or other urinary diversion. If you have a cystectomy to treat bladder cancer, your doctor will recommend regular follow-up visits to check for cancer recurrence.
Return to activities
During the first six weeks or so after surgery, you may need to restrict activities such as lifting, driving, bathing, and going back to work or school. You should be able to shower soon after surgery.
A cystectomy and urinary diversion are important life-extending treatments. But these surgeries do cause lifelong changes in both urinary and sexual function that can affect your quality of life. With time and support, you can learn to manage these transitions. Ask your health care team if there are community resources or support groups that may help you.
A neobladder works much like your original bladder. But it may take some time for the neobladder to work well. Immediately after surgery, you may have trouble controlling your bladder (urinary incontinence). This may happen until the neobladder stretches to a typical size and the muscles that support it get stronger. It helps to keep a regular voiding schedule. You may need to use a catheter to fully drain your bladder.
If you have a stoma, proper care of the stoma helps avoid complications. You will need to empty a urine-collecting bag or use a catheter through the stoma several times a day. You'll also need to pay careful attention to instructions for maintaining and disposing of devices.
Your health care team can offer support and answer questions.
A cystectomy and urinary diversion often affect sexual activity. Your health care provider or a sexual health specialist can help you address concerns and recommend ways to improve sexual experiences between you and a partner.
For women, the removal of some vaginal tissue during surgery can make sexual stimulation or intercourse uncomfortable after surgery. Nerve damage also can affect arousal and ability to have an orgasm.
For men, nerve damage during surgery could affect ability to have erections. Removal of the seminal vesicles and the prostate means you will no longer ejaculate. While men may still be able to have orgasms, the orgasms will be "dry."
You may feel uncomfortable with intimacy because of a stoma or external pouch. To minimize possible leaks, empty the pouch before sex. A pouch cover, sash or snug-fitting top can secure the pouch and keep it out of your way. You may want to experiment with different sexual activities or positions to find what is comfortable for you.