Cystectomy

What is a cystectomy?

A cystectomy is a major surgery to remove some or all of your urinary bladder. This is the organ that holds your pee before it goes through your urethra and out of your body.

Surgeons usually perform a cystectomy to treat bladder cancer. But bladder removal surgery can also treat benign (noncancerous) conditions that affect your urinary system. This includes some issues present at birth.

Each year, about 11 out of 100,000 people in the U.S. get bladder cancer. Complete bladder removal is the treatment for 1 in 5 of them.

How should I prepare for a cystectomy?

Before a cystectomy, you’ll meet with a healthcare provider. They’ll check your general health and take your vitals (temperature, pulse and blood pressure). They’ll also talk to you about which surgical approach they’ll use to remove your bladder. Options include:

• Partial cystectomy: Your surgeon removes only part of your bladder. They repair the part that’s left and it stays in your body. If you have cancer, they’ll usually remove nearby lymph nodes as well to find out if cancer has spread.
• Simple cystectomy: Your surgeon will remove your bladder, but no structures around it. This approach treats benign bladder conditions like neurogenic bladder, radiation cystitis, urinary fistula and severe interstitial cystitis.
• Radical cystectomy: Your surgeon removes your entire bladder and nearby lymph nodes. Surgeons often remove some reproductive organs as well, like the prostate in men or part of the vagina in women.

Tell your healthcare provider about any prescription or over-the-counter (OTC) medicines you’re taking. These include herbal supplements. Aspirin, anti-inflammatory drugs, certain herbal supplements and blood thinners can increase your risk of bleeding. Be sure to check with your provider before stopping any medications.

Also, let your provider know about any allergies you have. Include all known allergies. These include medicines, latex, foods and skin cleaners like iodine or isopropyl alcohol.

Your provider will give you directions on eating and drinking before your cystectomy. You shouldn’t eat or drink anything after midnight the night before your surgery. If you must take medicines, you should take them with a small sip of water.

What happens during bladder removal surgery?

Your surgeon will operate using an open or minimally invasive approach. For an open procedure, they use a large cut and work directly inside your body cavity. For a minimally invasive surgery, they make small cuts and use a camera and tools attached to a surgical robot that the surgeon controls.

Your provider will:

1. Sedate you (put you to sleep) with general anesthesia.
2. Make one long vertical surgical cut of about 6 to 7 inches (15 to 18 centimeters) between your belly button and pubic bone (open approach only).
3. Make five to six small incisions (about half an inch or 1 cm) in your belly area (minimally invasive approach only).
4. Remove some or all of your bladder.
5. Perform reconstructive surgery to create a new way for pee to drain, like an ileal conduit/urostomy, Indiana pouch or neobladder. (Your surgeon will discuss which option makes the most sense for you based on your medical history and goals.)
6. Stitch your incisions and cover them with bandages.

How long does it take?

A cystectomy takes about six hours to perform.

What are the potential benefits and risks?

The main benefit of a cystectomy is that it treats bladder cancer. It also treats other noncancerous conditions that affect your bladder or urinary system.

But like any major surgery, a cystectomy poses risks, including:

• Bleeding
• Blood clots
• Infection
• Bowel complications
• Scar tissue that blocks the flow of pee from your kidneys
• Organ damage
• Reaction to anesthesia
• Healing problems
• Fluid buildup at surgical sites

What happens after a cystectomy?

After bladder removal surgery, your care team will:

1. Stop giving you anesthesia.
2. Move you to a recovery room.
3. Monitor your overall health.
4. Treat your pain.

As you recover, you may have a poor appetite and produce too much or too little poop. You may also have changes in how you pee after a cystectomy. Your bladder is smaller after a partial cystectomy, so you may need to go to the bathroom more often. It’s also normal to have mucus in your pee.

If a surgeon removes your whole bladder, you may pee in a different way. It depends on the type of reconstructive surgery you have. You can live without a bladder. After surgery, you’ll have a new reservoir to hold pee that your kidneys produce. And you can still do many of the activities you did before surgery.

A cystectomy may cause sexual side effects. You may have trouble getting aroused. Intercourse may be uncomfortable if a provider removes part of your vagina.

What is the recovery time?

Your hospital stay depends on the type of cystectomy you have. You’ll typically spend at least one day in the hospital after a minimally invasive procedure. For an open cystectomy, you may need to stay in the hospital for up to a week.

During your hospital stay, providers will monitor your recovery. They’ll make sure you’re starting to heal and aren’t having issues with pain. If you need an ostomy bag for pee, they’ll teach you how to attach, empty and change it.

A complete recovery from a cystectomy may take several weeks to months. During this time, you’ll have follow-up visits with your provider to make sure you’re able to drain pee in the new way they created.

Your recovery depends on the type of bladder removal surgery you have. Typically, most people who have a partial cystectomy will have a shorter recovery period than people who have a radical one.

After a few weeks, you should be able to return to work or school and resume light physical activities. You should wait about six weeks to exert yourself.

When should I call my healthcare provider?

After a cystectomy, contact your provider right away if you notice any of the following symptoms:

• Signs of infection, like fever, chills and dark, cloudy pee
• Long-lasting nausea and vomiting
• Heavy bleeding at your surgical sites
• Increasing color changes, swelling, pain or pus from your surgical sites
• Black, brown or dark purple skin color changes of your stoma (new opening for pee)
• Excessive pain that you can’t control with your prescribed medicines
• Inability to pee or difficulty draining your pee

What are the long-term effects of cystectomy?

The long-term effects are more often from the urinary diversion a surgeon creates. Having to pee differently can affect your ability to pee on your own. It can also affect your sex life and how you feel about your body.

What is the survival rate for a cystectomy?

A Finnish study found that the overall survival rate after a radical cystectomy was 66% (about 6 out of 10 people) after five years. In 10 years, 55% (about 5 out of 10 people) survived. People in the study had this surgery to treat bladder cancer.

It’s important to talk to your healthcare provider about what survival rates mean for your situation.