What is a bladder surgery?
Cleveland Clinic offers minimally invasive treatment options for patients with localized muscle-invasive bladder cancer. The robotic laparoscopic bladder surgery procedure offers advantages over open radical cystectomy (removal of the bladder using a relatively large abdominal incision) in that there is a quicker recovery time and only a few small Band-Aid™ sized incisions.
Cleveland Clinic urologists performed the world's first laparoscopic removal of a cancerous bladder, followed by surgery to reconstruct the bladder out of intestinal tissue. Developed by a Cleveland Clinic urologist, our team first refined this technique in the laboratory and now offers the reconstructive bladder cancer surgery for patients.
Why would someone need bladder surgery?
Surgery for Bladder Cancer
Bladder cancer is the most common reason for patients to undergo bladder surgery. Depending on the stage and progression of a patient's bladder cancer, surgery can be used in combination with other therapies such as chemotherapy or radiation therapy. To treat bladder cancer, many different types of procedures can be done:
- Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra. A tool with a small wire loop on the end is then used to remove the cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
- Radical cystectomy: Surgery to remove the bladder and any lymph nodes and nearby organs that contain cancer. This surgery may be done when the bladder cancer invades the muscle wall, or when superficial cancer involves a large part of the bladder.
- Segmental cystectomy: Surgery to remove part of the bladder. This surgery may be done for patients who have a low-grade tumor that has invaded the wall of the bladder but is limited to one area of the bladder. Because only a part of the bladder is removed, patients are able to urinate normally after recovering from this surgery.
- Urinary diversion: Surgery to make a new way for the body to store and pass urine.
- Partial cystectomy - Removal of only a portion of the bladder is a viable option when a tumor is invasive but all evidence indicates that it is a solitary tumor limited to a defined region of the bladder. The procedure reduces the size of the bladder but preserves a significant portion.
- Radical cystectomy - This procedure involves complete removal of the bladder. An incision is made in the abdomen and the bladder and adjacent organs are carefully examined to determine the status of the cancer and see if it may have spread to adjacent structures and organs. The bladder is removed along with any other organs that may be affected.
Additionally in severe cases of a cystocele may require reconstructive surgery called an anterior repair to move the bladder into a normal position. In this type of surgery, an incision (cut) is made in the wall of the vagina and the tissue that separates the bladder from the vagina is tightened. The surgeon might also implant permanent mesh grafts made of synthetic or biologic materials to improve vaginal support.
Reconstructive Bladder Surgery
Sometimes, reconstructive bladder surgery is needed or desired for patients who have lost a bladder. In a procedure called urostomy, a segment of intestine is removed and reattached to the ureters. This leads urine from the kidneys an opening (stoma) near the belly button. A light, leak proof bag is attached to the stoma to collect urine. The bag can be emptied as needed.
A segment of intestine can also be formed into a small pouch or a larger "neobladder." The pouch or bladder is placed in the cavity left by the bladder and stores urine. A conduit, again made from intestine, leads to a stoma in the abdomen but in this instance a valve allows the pouch to be drained whenever he or she wishes. No bags are involved. The neobladder may be attached to the urethra to allow urine to be drained normally. The application of these procedures is dependent upon a number of factors. They are not available to all patients but these bladder cancer treatments can be successfully implemented in many.
What happens before bladder surgery?
As with all surgeries, you’ll be asked to stop taking aspirin, NSAIDS (including Advil, Ibuprofen, and Aleve) or other blood thinning medications at least a week prior to surgery. Because certain herbal medications or supplements also increase risk of bleeding during surgery, your doctor will advise you which supplements to cease using before surgery. Ask your doctor about using other medications such as antibiotics or blood pressure medication prior to surgery. Do not discontinue any medication without being advised by your doctor to do so.
Other medications such as Warfarin or Plavix also may need to be ceased at least 5 days before surgery to decrease bleeding risk.
Your doctor will also ask you to stop smoking. Besides the negative health consequences that smoking has, smoking can lead to higher risks both during and after surgery. Tobacco has been proven to slow down the healing process and decrease the effectiveness of the immune system.
Your diet will have to change the day prior to surgery most doctors recommend that you should follow a clear liquid diet starting the morning before your surgery.This includes juices without pulp, soup broth, and Jell-O.
It is also important to arrange for someone to care for you after surgery as returning to normal activity is not recommended immediately after surgery.
What happens during bladder surgery?
There is no one way to approach all bladder surgeries. Each condition that is being treated with bladder surgery requires a different approach or different surgery. When you talk to your doctor about undergoing bladder surgery, make sure you feel comfortable with what is being explained to you. Cleveland Clinic has the foremost experts in bladder surgery who will take time to discuss each step of the process with you so that you know exactly what occurs during bladder surgery.
Most bladder surgeries are done laproscopically at Cleveland Clinic. This means that instead of an "open" surgery, which requires one large incision, your doctor will use a few much smaller incisions. Doing surgery this way reduces healing time, risk factors, and reduces scarring during the healing process.
What happens after bladder surgery?
The specifics of recovering from bladder surgery depends a lot upon the type of bladder surgery that you have. For example, in a transurethral resection much less tissue is removed or changed in the surgery than during a radical cystectomy where the entire bladder is removed. Thus, the recovery time after your procedure can vary from a few weeks to a few months. Your Cleveland Clinic doctor will help guide you through the recovery process including a "voiding trial" (where your doctor will test your ability to void urine on your own after surgery) and catheter care instructions.