Cystectomy

Surgery Overview

Cystectomy is the surgical removal of all or part of the bladder. It is mainly used to treat bladder cancer that has spread into the bladder wall or to treat cancer that has come back (recurred) after treatment.

• Partial cystectomy takes out part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area. It's only a good choice if the cancer isn't near the openings where urine enters or leaves the bladder.
• Simple cystectomy takes out all of the bladder.
• Radical cystectomy takes out the entire bladder, nearby lymph nodes (lymphadenectomy), part of the urethra, and nearby organs that may contain cancer cells.
  • In men, the prostate, the seminal vesicles, and part of the vas deferens are also removed.
  • In women, the cervix, the uterus, the ovaries, the fallopian tubes, and part of the vagina are also removed.

The surgery is done through a cut (incision) the doctor makes in your lower belly. Sometimes it can be done as laparoscopic surgery, which requires only small cuts. To do this type of surgery, a doctor puts a lighted tube, or scope, and other surgical tools through small cuts in your lower belly. The doctor is able to see your organs with the scope.

If you have a cystectomy, your doctor will create a new way to pass urine from your body. There are several ways this can be done, such as:

• An ileal conduit. It uses a piece of your small intestine to make a tube. After surgery, the urine passes from the ureters through the conduit and out the opening into a plastic bag that is attached to your skin.
• A continent reservoir. It uses a piece of your bowel to create a storage pouch that is attached inside your pelvis. There are two types. Both types let you control when you urinate.

What To Expect

A cystectomy usually requires a hospital stay of about a week. You will probably need 6 to 8 weeks to fully recover. If your surgery was done to treat bladder cancer, you may need other treatments after that. This may include chemotherapy or radiation therapy. Your doctor will set up a regular schedule of checkups and tests.

If just part of your bladder was removed, you will probably be able to pass urine as you did before the surgery. Your bladder may not hold as much urine for a while. You may need to pass urine more often at first. But later your bladder should adjust so it can hold more urine.

If all of your bladder was removed, you will need to learn how to care for your ileal conduit or continent reservoir. A wound ostomy continence nurse (WOCN) is trained to teach you how to do this.

Bladder cancer surgery may affect sexual function. If a woman's uterus and ovaries are removed during surgery, she will not be able to get pregnant. And she may start menopause. She may have hot flashes and other symptoms. And if a man's prostate gland and seminal vesicles are removed, he may have problems getting erections. And he will not be able to make a woman pregnant. If a man may want to father a child, he should talk to his doctor. It may be possible to save his sperm before the surgery.

You may feel sad or depressed. Or you may worry about how your body will look after surgery. You may worry about whether the surgery will affect your sex life. These concerns are common. Call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org to learn more.

Why It Is Done

A cystectomy is mainly used to remove and try to cure cancer that has invaded the wall of the bladder or has come back (recurred) after treatment or that has a high chance of spreading.

How Well It Works

For bladder cancer that has spread to the muscle layer, radical cystectomy is the best treatment for preventing the spread or recurrence of cancer and helping people live longer.^{footnote 1}

Risks

Complications are common after a radical cystectomy. They may include short-term and longer-term problems.^{footnote 2}

Short-term problems

These include:

• Acidosis. This is an imbalance in electrolytes such as calcium and potassium. It can be caused by using a part of the intestine to divert urine after a cystectomy. People with acidosis often need to take medicine to control it.
• Leaking urine or stool.
• Bowel obstruction.
• Kidney infection.

Long-term problems

These include:

• An obstruction of the ureters or intestines.
• Kidney problems, such as renal failure.
• Problems with the newly created opening (stoma).
• Scar tissue that forms inside the intestines (strictures).