Bladder removal surgery, or cystectomy, is the removal of the urinary bladder. After this procedure, a surgeon must create a new pathway for urine to leave the body.
A person should prepare fully before going into bladder removal surgery. This includes having an understanding of how their life will be different afterward. Preparation can help the individual set reasonable expectations for their post-surgery life.
Bladder removal surgery procedures and people’s recovery may be different for males and females.
This article discusses the procedure for bladder removal surgery, what to expect during recovery, and post-surgery quality of life.
Surgical removal of the bladder is a common treatment for bladder cancer. Surgeons also sometimes perform it to treat other tumors in the pelvis or interstitial cystitis that does not respond to other treatments.
When bladder cancer has not progressed to an advanced stage, a doctor may be able to treat it using less invasive options than bladder removal surgery. However, if the cancer is more advanced, removing the bladder may be the safest option to help stop the cancer from spreading to other areas of the body.
A person should go into bladder surgery having explored all of their options. Often, the specific surgical possibilities that are right for a particular person will depend on:
- their overall health
- the stage of their cancer
- where the cancer has formed
- whether or not the cancer is recurring
Although their basic surgical options are the same, males and females may have various other organs removed based on their natal sex.
There are two different surgical options for basic bladder removal surgery. These are partial cystectomy and radical cystectomy.
Partial cystectomy takes place when the cancer is located in only one spot on the bladder wall, and it has not spread to the opening where urine leaves the body.
Radical cystectomy involves the removal of the entire bladder, surrounding lymph nodes, and possibly other organs.
When a male undergoes radical cystectomy, the surgeon may also remove:
- part of the vas deferens, or sperm duct
- the glands that secrete semen
- the prostate
When a female undergoes radical cystectomy, the surgeon may also remove:
- the cervix
- the ovaries
- the uterus
- the fallopian tubes
- parts of the vagina
When the surgeon removes the bladder, they need to create an alternate means for urine to leave the body. There are two options for this procedure: continent diversion and incontinent diversion.
In the case of continent diversion, a person will have control over when they evacuate urine from the body.
There are two subtypes of continent diversion based on whether or not a surgeon has removed the urethra. Both involve the use of a urine reservoir. They are called bladder substitution reservoir and continent diversion reservoir with a stoma.
With bladder substitution reservoir, the urethra remains intact, so the surgeon can connect the urine reservoir between the ureters and the urethra. Urination works by increasing abdominal pressure to push urine out.
With continent diversion reservoir with a stoma, the urethra is no longer present, so the surgeon will place the reservoir near the abdomen wall. A catheter can remove urine from the pouch through a small hole called a stoma in the abdomen wall.
Surgeons create these urinary diversions using the small or large bowel, isolating a segment for urinary diversion and then putting the rest of the bowel back into continuity.
Incontinent diversion involves using an intestinal segment called an ileal conduit to create a tube that connects the ureters to an opening in the abdominal wall.
With this option, the urine will pass through the new opening into a pouch attached to the person’s side.
People should discuss their potential options with a doctor, including the specific steps they should take to prepare for the surgery. These steps include what time to stop eating and drinking the night before the procedure.
People should also prepare a list of questions or concerns they have about their procedure and recovery so that they can talk with the doctor about what to expect post-surgery.
A person will be under general anesthesia during surgery to remove the bladder. They may feel groggy from the anesthesia when waking up immediately following the surgery.
A doctor is likely to prescribe medications, such as narcotics or an epidural, to manage the pain.
Typically, once a person’s condition stabilizes, they will move from a post-operative room to a regular hospital room for about a week. During this time, their care team will assess the new system for urine evacuation.
The medical team will not release the individual from the hospital until they are sure that the new urine evacuation system functions correctly.
In some cases, people will have to undertake new steps to evacuate urine after they have had their bladder removed. When this occurs, hospital staff will teach both the person and their caregiver how to remove the urine.
After leaving the hospital, the person should expect to take several weeks for recovery. During this time, their body is healing from the surgery, so they should only perform light activities.
After 4–6 weeks, doctors will usually allow a person who has had their bladder removed to resume normal activities.
The person will likely need to follow up with a doctor within the first few weeks after surgery to prevent complications and assess how the surgical site is healing. These visits also allow the person to troubleshoot any problems with their new method of urinating.
As with all surgeries, there is the potential for complications after bladder removal surgery. The most common problems may include:
- urinary tract infections
- ileus, or paralyzed intestine function
- bleeding or blood clots
- reactions to anesthetics
- infections near the incision site
- damage to other organs or tissue
After the surgery, a person may also experience complications related to their new urinary system. These complications may include:
- urine leakage
- pouch stones
- sexual issues, such as a loss of sensation, an inability to orgasm, or erectile dysfunction
- blocked urine path
Since bladder removal surgery involves restructuring the way urine exits the body, a person may initially experience a decrease in their quality of life. However, managing urine secretion usually becomes easier as time goes on.
Immediately following surgery, doctors usually restrict what the person can do. This restriction, though temporary, may feel frustrating.
It is common for the new urinary system, such as urinary sacks or stomas, to feel uncomfortable at first. If the person has trouble adjusting, they may want to discuss their concerns and feelings with a doctor, social worker, or counselor. Joining a support group can also help.
The person should be able to return to all their normal life activities within 4–6 weeks following surgery.
During recovery, the person will be able to get used to their new means of urinating. As their familiarity with the new urinary system grows, any inconvenient symptoms should lessen.
According to the American Cancer Society, the 5-year relative survival rate for all stages of bladder cancer combined is 77%. A person’s 10-year relative survival rate is about
A relative survival rate helps give an idea of how long a person with a particular condition will live after receiving a diagnosis compared with those without the condition. For example, if the 5-year relative survival rate is 77%, it means that a person with the condition is 77% as likely to live for 5 years as someone without the condition.
It is important to remember that these figures are estimates. A person can talk with a doctor about how their condition is likely to affect them.
Most people will experience full physical recovery following their surgery. However, many people experience increased anxiety, and it may take them some time to adjust to their new way of urinating.
Support groups can help a person emotionally to handle surgery, recovery, and life after surgery. Social workers and counselors may also be good options.