A cystectomy is an operation to remove your bladder. This is a big operation. You might be in hospital for between 5 and 14 nights.
After surgery to remove your bladder, you need another way to collect and pass your urine. Doctors call this urinary diversion. There are different types of urinary diversion. Your doctor will talk to you about the different types and which ones might be suitable for you.
For some rarer types of bladder cancer, the surgeon might only remove part of your bladder. This is called a partial cystectomy.
When you might have surgery to remove your bladder
You might have this surgery for:
- non muscle invasive bladder cancer - this means the cancer is only in the bladder lining, or the connective tissue beneath the bladder lining
- muscle invasive - this means the cancer has grown into the deeper (muscle) layer of the bladder, or beyond
For non muscle invasive bladder cancer you might have a cystectomy if your cancer:
- is at a very high risk of spreading or coming back
- comes back or doesn't respond to BCG (immunotherapy) treatment into your bladder
Cystectomy is one of the main treatments for muscle invasive bladder cancer that hasn't spread.
What is a cystectomy?
A radical cystectomy means taking out the whole bladder and the nearby lymph nodes.
Your surgeon will also remove part of your bowel. This is so your surgeon can create another way for your body to collect and pass urine. Your surgeon will discuss this with you beforehand.
In men, the surgeon also usually removes:
- the prostate gland
- the glands that store semen (seminal vesicles)
In women, the surgeon usually removes:
- the womb
- the fallopian tubes
Sometimes the surgeon removes your ovaries and part of your vagina. Your surgeon talks this through with you beforehand.
Removing part of the bladder (partial cystectomy)
Removing part of the bladder is not a common operation for bladder cancer. It is usually a treatment for a 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 do you pass urine after a cystectomy?
After surgery to remove your bladder, you need another way to collect and pass your urine. Doctors call this urinary diversion. There are different types of urinary diversion. Your surgeon will discuss the most suitable options for you. They will also tell you about the benefits and complications of each type.
You might have:
- a bag outside your body to collect urine (urostomy or ileal conduit)
- an internal pouch to collect urine (continent urinary diversion)
- a new bladder (bladder reconstruction or neobladder)
- a pouch made from your back passage (recto sigmoid pouch)
Urostomy or ileal conduit
This is the most common way to collect your urine. A urostomy means you have a bag outside your body to collect your urine.
The surgeon creates a new opening (stoma) for your urine to pass through. This can also be called an ileal conduit.
Continent urinary diversion
A continent urinary diversion is an internal pouch. The surgeon makes the pouch from a section of your bowel. The pouch stores your urine. Your surgeon makes a new opening called a stoma on your tummy (abdomen) for the urine to pass through.
This way of collecting urine allows you to control (be continent) when urine comes out. You don’t have to wear a bag to collect urine. You pass a thin tube (catheter) into the stoma to pass urine. This is called self catheterisation.
It is a longer operation than a urostomy and it is less common. You will have to carry on self catheterising for the rest of your life. And there is a risk that you might need further surgery in the future.
Bladder reconstruction (neobladder)
Your surgeon might make you a new bladder (neobladder) from a section of your bowel. After surgery, you pass urine through your urethra as you did before. It will feel different, and you have to learn how to do this.
It is a longer operation than a urostomy and is less common. You have to pass a thin tube (catheter) through your urethra if you are unable to empty your new bladder. And there is the risk that you will need further surgery in the future.
Recto sigmoid pouch
A recto sigmoid pouch is when your back passage (rectum) is made into a pouch to collect urine like a bladder. After this surgery you pass urine out with your poo from your rectum.
This type of diversion is very uncommon. It is only carried out in a few hospitals, by highly specialist surgeons.
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.
After a big operation, you may wake up in the intensive care unit or a high dependency recovery unit. You usually move back to the ward within a day or so.
You usually stay in hospital for a 1 or 2 weeks.
Problems after surgery
There is a risk of problems or complications after any operation. Many problems are minor but some can be life threatening. Treating them as soon as possible is important.
We have a general page about problems after cystectomy and urinary diversion.
Some of the possible problems depend on which type of urinary diversion you have.