Types of surgery for invasive bladder cancer
This page tells you about the different operations for invasive bladder cancer. You can find information about
Removing part of the bladder (partial cystectomy)
This is suitable for only a small number of bladder cancers.
Removing the whole bladder (radical cystectomy)
As well as removing the bladder, the surgeon removes the surrounding lymph nodes. In men, the surgeon will also take out the prostate gland. In women, the surgeon removes the tube that takes urine from the bladder to the outside of the body (the urethra). The surgeon may want to remove the womb and ovaries as well.
When your bladder is removed, you need another way of collecting your urine. There are several different ways of doing this. The most common is to have a urostomy. This means having a bag outside your body to collect your urine.
Instead, some surgeons can use part of the bowel to make an internal pouch to hold your urine (a continent urinary diversion). Or your surgeon may make an artificial bladder for you (bladder reconstruction). Rarely, they may be able to make the back passage (the rectum) into a pouch where the urine is collected. After this operation, you pass urine out with the stools from your back passage. These operations are not suitable for everyone.
Look in the living with bladder cancer section for more information about life after surgery.
You can view and print the quick guides for all the pages in the Treating bladder cancer section.
Removing part of the bladder is not commonly used for bladder cancer. This type of operation is usually only possible if you have an adenocarcinoma of the bladder, which is not a common type. After partial cystectomy, you can pass urine in the normal way, but your bladder will be smaller and so you may need to go to the loo more often.
A radical cystectomy means taking out the whole bladder and the nearby lymph nodes. In men, the surgeon also takes the prostate out. In women the surgeon removes the tube that takes urine from the bladder to the outside of the body (the urethra). Your surgeon may want to take out the womb and ovaries as well. If this is a possibility, your surgeon will talk this through with you beforehand. The surgeon removes the prostate and urethra because bladder cancer can come back in these areas.
For men, having the prostate removed can cause problems getting an erection. For women, this type of operation may not physically affect your sex life. In some women, the vagina may be shortened or narrower after the surgery, and sensations during sex may feel different. There is information about bladder cancer treatment and your sex life in the living with bladder cancer section.
When your bladder is removed, you need to have another way of collecting your urine. There are several different operations. You may have
A urostomy is the most common and straightforward operation for invasive bladder cancer. It has been done since the 1950s and is also called an ileal conduit (pronounced eye-lee-al con-dwee).
While you are under anaesthetic, your surgeon removes your bladder. You have a small piece of your small bowel (ileum) removed and the cut ends are joined together. The tubes carrying urine from the kidneys (the ureters) are sewn into one end of the piece of bowel the surgeon removed. And they seal this end of the removed bowel. Next, the surgeon cuts a small hole in the surface of your tummy (abdomen). The open end of the piece of bowel is put into this hole. This makes a stoma. The stoma is usually put to the right of your tummy button. But you can talk to the surgeon about where it would be best to put it for you.
When the operation is finished, your urine will run down the ureters, through the piece of bowel and out through the stoma. You will need to wear a waterproof bag (urostomy bag) over the stoma to collect the urine. The bag sticks over the stoma. You can empty the bag as often as you would normally go to the toilet to pass urine. Look at the living with bladder cancer section for more information about life after bladder surgery.
This is a newer operation than the urostomy. It means that you do not have to wear a bag to collect your urine. It is a more difficult operation than the urostomy and needs to be carried out by a specialist surgeon. Because the operation is more complicated, about 1 in 5 people need further surgery to correct problems afterwards.
The surgeon takes a piece of your bowel and makes it into a pouch inside the body. The pouch opens out from the abdomen through a stoma (like the urostomy). Usually, the surgeon makes the stoma under your tummy button (navel), so that it does not show under clothes.
The urine does not leak out of the stoma. The stoma is made from the part of the bowel where the large and small bowel join and there is a natural valve that keeps the stoma closed. When you want to empty the pouch, you put a thin tube (catheter) into the stoma and drain off the urine. You will need to do this at least 4 or 5 times a day. And you must be as clean and careful as possible so that you don't get an infection. If you let the pouch get too full, it may leak. Look at the living with bladder cancer section for more information about life after bladder surgery.
This is a newer operation for bladder cancer and is carried out by specialist surgeons. This operation isn't possible for everyone and is only suitable for you if
- You are at low risk of your cancer coming back
- Your cancer did not affect your urethra
- You do not have any bowel problems such as Crohn's disease
There are several ways of doing this operation. Usually, the surgeon uses part of your small bowel to make a new bladder. They sew the ureters and the remaining part of your urethra to the new bladder. So after your operation, urine flows down the ureters as normal, and collects in the pouch forming your new bladder. This operation is more complicated than a urostomy and some people need further surgery to correct problems afterwards.
When you want to pass urine, you hold your breath and push down into your abdomen. It is a bit like pushing to open your bowels, but you use the muscles closer to the front of your tummy instead of those near your back passage. Doctors call this the Valsalva manoeuvre. You have to remember to go to the toilet and do this regularly. You won't have the nerve supply that tells you when your bladder is full.
After this operation some people leak urine from the new bladder (are incontinent), especially at night when they are asleep. Some people find it difficult to learn to pass urine naturally and have to regularly put a catheter into the new bladder to drain it.
In some people the cancer may come back in your urethra. If it does, you will then need to have an operation to remove the urethra and make a stoma. So you would then have the ordinary sort of urostomy.
If you can't have a bladder reconstruction because the cancer is close to, or inside, the urethra, your surgeon may be able to make a recto sigmoid pouch. This operation is also called a Mainz 2 procedure. This is a newer type of operation for bladder cancer and is carried out by specialist surgeons. The surgeon makes the back passage (rectum) into a pouch by adding a piece of bowel taken from higher up. They then attach the ureters to the pouch. The pouch collects the urine and you need to use the muscle in your bottom (anal sphincter) to hold it in.
After this operation you pass urine out with the stools from your back passage. You need to go to the toilet every 2 to 3 hours to do this. You also need good control of the muscle at the end of the bowel so that you don't leak urine and stools.
You are more likely to get kidney infections after this operation, because bacteria can travel up the ureters to the kidney from the bowel. So you need to drink plenty of liquids to try to prevent infection.
Keyhole surgery means using a laparoscope to do surgery. A laparoscope is a long tube with an eyepiece at one end and a camera at the other. This type of surgery can be used to remove the bladder (laparoscopic cystectomy) through several very small cuts in the tummy (abdomen). So you only have a few small wounds and can recover from your operation more quickly. In February 2009 the National Institute for Clinical Excellence (NICE) approved laparoscopic cystectomy for use on the NHS. Making a urinary diversion or a new bladder can also sometimes be carried out using keyhole surgery but these operations are more usually done with normal surgical techniques.
Some hospitals are starting to use a machine (robot) to control the laparoscopic instruments during surgery. This is called robotically assisted laparoscopic surgery.
You can talk to your surgeon about whether this type of surgery may be suitable in your case. It is not possible for some people because the surgeon may not be able to see the area of the bladder as clearly as with open surgery and there is a higher chance of bowel complications. The surgeon needs to be experienced in keyhole surgery techniques and so this operation is not available at all hospitals in the UK.
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