Bladder removal surgery, also called cystectomy, is the removal of the urinary bladder. After this surgery, a doctor must create a new pathway for urine to leave the body.
A person should prepare fully before going into bladder removal surgery, including having an understanding of how their life will be different afterward. Preparation can help the individual set reasonable expectations of their post-surgery life.
Bladder removal surgery procedures and a person's recovery may be different for men and women.
In this article, we take a close look at the procedure for bladder removal surgery or cystectomy, what to expect during recovery, and quality of life after.
Surgical removal of the bladder is the most common treatment for bladder cancer. It is also sometimes used to treat other tumors in the pelvis, abnormalities, 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 cancer from spreading to other areas of the body.
A person should go into bladder surgery knowing all their options. Often, the specific surgical possibilities that are right for a particular patient will depend on:
- their overall health
- the stage of cancer
- where cancer has formed
- whether the cancer is recurring
Though their basic surgical options are the same, men and women may have various other organs removed based on their biological sex.
There are two different surgical options for basic bladder removal surgery. These are:
- A partial cystectomy, which is done 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.
- A radical cystectomy, which involves the removal of the entire bladder, surrounding lymph nodes, and possibly other organs.
When a man has a radical cystectomy, the doctor may also remove:
- part of the vas deferens or sperm duct
- the glands that secrete semen
- the prostate
When a woman undergoes a radical cystectomy, the doctor may also remove:
- the cervix
- the ovaries
- the uterus
- the fallopian tubes
- parts of the vagina
When the bladder is removed, the doctor will need to create an alternate means for urine to leave the body. There are two options for this procedure:
1. Continent diversion
In the case of continent diversion, a person will have control over when they evacuate urine from the body.
There are two types of continent diversion based on whether or not the urethra has been removed. Both involve the use of a urine reservoir.
- Bladder substitution reservoir. The urethra remains intact so the urine reservoir can be connected between the ureters and the urethra. Urination works similarly to how it did prior to surgery.
- Continent diversion reservoir with a stoma. The urethra was removed so the reservoir will be placed near the abdomen wall. A catheter is used to remove urine from the pouch through a small hole called a stoma in the abdomen wall.
2. Incontinent diversion
Incontinent diversion involves using the intestine to create a tube that connects the ureters to an opening in the wall of the stomach.
With this option, the urine will pass through the new opening into a pouch attached to the person's side.
A person should discuss the potential options with their doctor, including the specific steps they should take to prepare for the surgery. These steps include what time to stopping eating and drinking the night before the procedure. Usually, it is midnight.
People should also prepare a list of questions or concerns about the procedure they will have and their recovery so they can talk to their doctor about what to expect post-surgery.
A person is put under general anesthesia during surgery to remove the bladder. The person is likely to 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 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 caregivers how to remove the urine.
After leaving the hospital, a person should expect to take several weeks for recovery. During this time, their body heals from the surgery, and they should only perform light activities.
After 4 to 6 weeks, doctors will usually allow a person who has had their bladder removed to resume normal activities.
A person will likely need to follow up with their 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 always the potential for complications after surgery to remove the bladder. The most common problems may include:
- bleeding or blood clots
- reaction to anesthesia
- infection near the incision
- damage to other organs or tissue
After the surgery, a person may experience complications related to their new urinary system. These complications may include:
- urine leakage
- pouch stones
- sexual issues such as loss of sensation, 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 becomes easier as time goes on.
Immediately following surgery, doctors usually restrict what a person can do. This restriction, though temporary, may feel frustrating.
It is common for the new urinary system, for example, urinary sacks or stomas, to feel uncomfortable at the start. If a person has trouble adjusting, they may want to discuss their concern and feelings with a doctor, social worker, or counselor. Joining a supportive community can also help.
A person should be able to return to all their normal life activities within a few weeks following surgery.
During recovery, a person will be able to get used to the new means of urinating. As their familiarity with the new urinary system grows, any inconvenience symptoms should lessen.
According to the American Cancer Society, a person's five year, the relative survival rate is 77 percent. A person's 10 year, relative survival rate is about 70 percent and the 15 year, relative survival rate is 65 percent. These numbers are based on all stages of bladder cancer.
Most people will experience full physical recovery following their surgery. However, many will experience increased anxiety, and it may take them some time to adjust to a new way of urinating.
Many support groups can help a person, emotionally, to handle surgery, recovery, and life after surgery. If support groups are not available, social workers or counselors may be a good option.