This is an operation to remove all or part of your bladder. You might have this if you have high risk early bladder cancer. You have this operation whilst you are asleep (general anaesthetic).
Removing the whole bladder (radical cystectomy)
A radical cystectomy means taking out the whole bladder and the nearby lymph nodes.
In men, the surgeon also removes the prostate gland and glands that store semen (seminal vesicles). This is because bladder cancer can come back in this area. In women, the surgeon usually removes the womb and fallopian tubes. Sometimes the surgeon removes your ovaries and part of your vagina. Your surgeon talks this through with you beforehand.
You may also have part of your bowel removed. This is so your surgeon can create another way for your body to collect and pass urine. It's called a recto sigmoid pouch. Your surgeon will discuss this with you beforehand if you're having this operation.
When your bladder is removed, you need to have another way to collect and pass your urine. There are several choices of operations. You might have a:
- bag outside your body to collect urine (urostomy or ileal conduit)
- pouch to collect urine (continent urinary diversion)
- a new bladder made (bladder reconstruction)
- a pouch made from your back passage (recto sigmoid pouch)
Possible side effects
This operation may physically or emotionally affect your sex life. For men, having the prostate removed can cause problems getting an erection. For some women, the vagina may be shortened or narrower after the surgery and sensations during sex may feel different.
Having the lymph nodes around your bladder removed puts you at risk of lymphoedema in your legs. Surgery can cause damage to the lymph pathways and block the normal drainage of lymph fluid.
Having a recto sigmoid pouch can cause bowel changes. This is because part of your bowel has been removed and is now shorter. You may notice that:
- your poo is looser than normal
- you go to the toilet more frequently
- you get constipated and need medicine to help you go
It can take some time to return to normal, often a few months or longer.
Removing part of the bladder (partial cystectomy)
Removing part of the bladder is not a common operation for bladder cancer. It is usually used to treat the very rare type of cancer called adenocarcinoma of the bladder.
After having a partial cystectomy, you can pass urine in the normal way. But your bladder will be smaller so you may need to go to the toilet more often.
How you have surgery
This means your surgeon makes one long cut in your tummy (abdomen) to remove your bladder.
Keyhole surgery (laparoscopic surgery)
Keyhole surgery is also called minimal access or laparoscopic surgery. Instead of one large wound site on your abdomen you have several smaller wounds, Generally, with keyhole surgery people recover quicker.
The surgeon makes several small cuts on your tummy (abdomen). They put small surgical instruments and a laparoscope through these to carry out the operation. A laparoscope is like a narrow telescope that lights and magnifies the inside of your body. Your surgeon can see the images on a TV screen.
Some of the advantages of having surgery this way include:
lower length of stay in hospital
you need less pain medication
you lose less blood during the operation, so you need fewer blood transfusions
This is where the surgeon uses a machine (robot) to control the laparoscopic instruments during surgery. This is called robotically assisted laparoscopic surgery.
This is becoming the more common way of doing this cystectomy operation in the larger hospitals. Your surgeon may ask you to join a clinical trial to look at the benefits between open surgery and robotic surgery.