Overview
Female urinary system
Female urinary system
Your urinary system includes the kidneys, ureters, bladder and urethra. The urinary system removes waste from the body through urine. The kidneys are located toward the back of the upper abdomen. They filter waste and fluid from the blood and produce urine. Urine moves from the kidneys through narrow tubes to the bladder. These tubes are called the ureters. The bladder stores urine until it's time to urinate. Urine leaves the body through another small tube called the urethra.
Male urinary system
Male urinary system
Your urinary system includes the kidneys, ureters, bladder and urethra. The urinary system removes waste from the body through urine. The kidneys are located toward the back of the upper abdomen. They filter waste and fluid from the blood and produce urine. Urine moves from the kidneys through narrow tubes to the bladder. These tubes are called the ureters. The bladder stores urine until it's time to urinate. Urine leaves the body through another small tube called the urethra.
Cystectomy (sis-TEK-tuh-me) is a surgery to remove the urinary bladder.
The procedure to remove the entire bladder is called a radical cystectomy. In men, this typically includes removal of the prostate and seminal vesicles. In women, radical cystectomy usually includes removal of the uterus, ovaries, fallopian tubes and part of the vagina.
After removing your bladder, your surgeon also needs to create a new way to store urine and have it leave your body. This is called urinary diversion. Your surgeon will discuss the options for urinary diversion that may be appropriate for you.
A radical cystectomy is performed to treat cancer that has invaded muscle tissue of the bladder or recurrent noninvasive bladder cancer. A partial cystectomy, although rarely performed, is used to remove a cancerous tumor in an isolated portion of the bladder. A simple cystectomy — removal of only the bladder — may be a treatment for noncancerous (benign) conditions.
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Why it's done
Your health care provider may recommend cystectomy to treat:
- Cancer that begins in or spreads to the bladder
- Irregularities in the urinary system present at birth
- Neurological or inflammatory disorders that affect the urinary system
What type of cystectomy and reconstruction you have depends on many things, such as the reason for surgery, your overall health, and your preferences and care needs.
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Risks
Cystectomy is a complex surgery. It involves the manipulation of many internal organs in your abdomen. Because of this, cystectomy carries with it certain risks, including:
- Bleeding
- Blood clots in the legs
- Blood clots that travel to the lungs or heart
- Infection
- Poor wound healing
- Damage to nearby organs or tissues
- Organ damage due to the body's overreaction to infection (sepsis)
- Rarely, death related to complications from surgery
Other risks associated with urinary diversion vary depending on the procedure, but complications may include:
- Dehydration
- Decline in kidney function
- Imbalance in essential minerals
- Vitamin B-12 deficiency
- Urinary tract infection
- Kidney stones
- Loss of bladder control (urinary incontinence)
- A blockage that keeps food or liquid from passing through your intestines (bowel obstruction)
- A blockage in one of the tubes that carries urine from the kidneys (ureter blockage)
Some complications may be life-threatening or require hospitalization. You may need another surgery to correct problems. Your surgical team will provide you with information about when to call your care team or when to go the emergency room during your recovery.
How you prepare
Before your cystectomy, you will talk to your surgeon, your anesthesiologist and other members of the care team about your health and any factors that may affect the surgery. These factors may include:
- Long-term medical conditions
- Drug allergies
- Previous reactions to anesthesia
- Obstructive sleep apnea
You should also review with the surgical team your use of the following:
- Prescription and nonprescription drugs
- Vitamins, herbal medicines or other dietary supplements
- Alcohol
- Cigarettes
- Recreational drugs
- Caffeinated beverages
If you smoke, talk to your health care provider about what help you may need to quit. Smoking can affect your recovery from anesthesia and surgery.
Diet and medications before surgery
Your surgeon may ask you to have a clear liquid diet for 1 to 2 days before surgery. You'll likely need to stop eating and drinking after midnight on the night before your procedure. You'll receive instructions on what medications you should not take in the days before surgery.
Urinary diversion procedure
Your surgical team will talk with you about the type of urinary diversion you'll have. With urinary diversion, you have a new way for urine to be stored and exit the body after the bladder is removed. The goals of urinary diversion are to allow the safe storage and timely elimination of urine. Your doctors also will want to preserve your quality of life as best as possible.
Different kinds of urinary diversion may require different devices. These may include tubes or urine collecting bags. These devices need to be used and cleaned correctly. A nurse or other member of your care team will train you on how to use and care for these devices. This will help you or a care provider be prepared to take on this role after your surgery.
What you can expect
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Cystectomy incision sites
Cystectomy incision sites
During an open cystectomy (left), a surgeon makes a cut that runs from just below the bellybutton to just above the pubic bone. In robotic surgery (right), a surgeon makes several small keyhole cuts to insert a viewing device (cystoscope) and surgical instruments.
Robotic cystectomy
Robotic cystectomy
During robotic cystectomy, your surgeon sits at a remote console and uses robotic arms to perform the procedure. A surgical team assists at the operating table.
Options for cystectomy surgery include:
- Open surgery. This approach uses a single incision on your abdomen to access the pelvis and bladder.
- Minimally invasive surgery. With minimally invasive surgery, the surgeon makes several small incisions in the abdomen where special surgical tools are inserted to access the abdominal cavity. This type of surgery is also called laparoscopic surgery.
- Robotic surgery. Robotic surgery is a type of minimally invasive surgery. The surgeon sits at a console and remotely operates robotic surgical tools.
During the procedure
Ileal conduit
Ileal conduit
During an ileal conduit procedure, a surgeon creates a new tube from a piece of intestine that allows the kidneys to drain and urine to exit the body through a small opening called a stoma.
Neobladder reconstruction
Neobladder reconstruction
During neobladder surgery, a surgeon takes out the existing bladder and forms an internal pouch from part of the intestine. The pouch, called a neobladder, stores urine.
Stoma and pouching system
Stoma and pouching system
A urinary conduit is a surgically created pathway that allows urine to exit the body. A urinary conduit doesn't store urine. After surgery, you need to wear a pouching system all the time to collect urine. Pictured is one example of a pouching system used to collect urine, which drains from an opening in the abdomen (urinary stoma). The wafer acts as a barrier to protect the skin around the stoma from exposure to urine. A urine collection bag connects to the wafer.
You're given a medicine (general anesthetic) that keeps you asleep during surgery. Once you're asleep, your surgeon cuts into your abdomen — one larger incision for open surgery or several smaller incisions for minimally invasive or robotic surgery.
Your surgeon removes the bladder from surrounding tissues. If the treatment is for bladder cancer, the surgeon will also remove nearby lymph nodes, which are part of the immune system. These will be looked at in a lab to see if cancer has spread to them.
In men, a radical cystectomy includes removal of the prostate and seminal vesicles. In women, it includes removal of the uterus, ovaries, fallopian tubes and part of the vagina. How much of the urethra is preserved depends on the type urinary diversion the surgeon will create.
After your bladder is removed, your surgeon creates a urinary diversion — a new system for removing urine. Options include:
- Ileal conduit. The surgeon uses a piece of the small intestine to create a tube (conduit). The ureters previously connected to the bladder are connected to the conduit. Urine drains into the conduit, passes outside the body through a hole in the wall of the abdomen (stoma) and fills a pouch worn under clothes. Urine continually collects in the pouch, which needs be drained frequently and regularly replaced.
- Continent urinary reservoir. During this procedure, the surgeon uses a piece of the intestines to create a pouch (reservoir) inside the abdomen. Like the ileal conduit, the reservoir is connected to ureters and a stoma in the abdominal wall. The reservoir, however, stores the urine. To drain it, you insert a thin tube (catheter) into the stoma.
- Neobladder reconstruction. The surgeon uses a portion of the intestines and reshapes the tissues into a spherical bladder. It is placed in the same location as the original bladder and attached to the ureters and urethra. The neobladder allows you to urinate much as you had with your original bladder. You may need to use a catheter inserted into your urethra to completely drain the new bladder.
After the procedure
After general anesthesia, you may have side effects such as sort throat, shivering, sleepiness, dry mouth, nausea and vomiting. You may receive medications to lessen symptoms.
Starting the morning after surgery, your health care team may have you get up and walk often. Walking promotes healing and the return of bowel function, improves your circulation, and helps prevent joint stiffness and blood clots.
The slow return of typical bowel function is a frequent delay to recovery after a radical cystectomy. If you have an open procedure, you'll likely be in the hospital for 5 to 7 days. With a minimally invasive procedure, your recovery time in the hospital may be shorter.
Before you leave the hospital, a nurse or other health care provider will give you written instructions about wound care and guidelines for when to call your care team or get urgent care. Depending on what type of urinary diversion procedure was performed, you'll also have instructions about care, cleaning and use of devices.
Follow-up appointments
You'll likely return to the clinic for follow-up care in the first few weeks after the cystectomy and again after a few months. At these appointments, your doctor will check to make sure that your upper urinary tract drains adequately and that you don't have electrolyte imbalances.
You'll have a lifelong schedule of regular follow-up appointments to monitor the function of the neobladder or other urinary diversion. If you have a cystectomy to treat bladder cancer, your doctor will recommend regular follow-up visits to check for cancer recurrence.
Return to activities
During the first six weeks or so after surgery, you may need to restrict activities such as lifting, driving, bathing, and going back to work or school. You should be able to shower soon after surgery.
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Results
A cystectomy and urinary diversion are important life-extending treatments. But these surgeries do cause lifelong changes in both urinary and sexual function that can affect your quality of life. With time and support, you can learn to manage these transitions. Ask your health care team if there are community resources or support groups that may help you.
Urine voiding
A neobladder works much like your original bladder. But it may take some time for the neobladder to work well. Immediately after surgery, you may have trouble controlling your bladder (urinary incontinence). This may happen until the neobladder stretches to a typical size and the muscles that support it get stronger. It helps to keep a regular voiding schedule. You may need to use a catheter to fully drain your bladder.
If you have a stoma, proper care of the stoma helps avoid complications. You will need to empty a urine-collecting bag or use a catheter through the stoma several times a day. You'll also need to pay careful attention to instructions for maintaining and disposing of devices.
Your health care team can offer support and answer questions.
Sexual changes
A cystectomy and urinary diversion often affect sexual activity. Your health care provider or a sexual health specialist can help you address concerns and recommend ways to improve sexual experiences between you and a partner.
For women, the removal of some vaginal tissue during surgery can make sexual stimulation or intercourse uncomfortable after surgery. Nerve damage also can affect arousal and ability to have an orgasm.
For men, nerve damage during surgery could affect ability to have erections. Removal of the seminal vesicles and the prostate means you will no longer ejaculate. While men may still be able to have orgasms, the orgasms will be "dry."
You may feel uncomfortable with intimacy because of a stoma or external pouch. To minimize possible leaks, empty the pouch before sex. A pouch cover, sash or snug-fitting top can secure the pouch and keep it out of your way. You may want to experiment with different sexual activities or positions to find what is comfortable for you.
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FAQs
Is a cystectomy major surgery? ›
The standard of care for patients with muscle-invasive bladder cancer is radical cystectomy, the surgical removal of the bladder. However, this is a major operation, with a significant risk of complications and potentially, even death.
What is the survival rate after cystectomy? ›After censoring of palliative cystectomies (10 and 27 patients from the elderly and younger groups respectively), the one-year overall mortality remained significantly higher in elderly: 43.8%, as compared to 30.85% in younger subgroup, p=0.004 (Table 5).
What is life like after cystectomy? ›The operation you had, called a cystectomy, is a lifelong change. You may have to bathe differently and adjust your travel habits. It can affect your body image, and you may worry about its impact on your relationships and sex life. With enough time, you should be able to do almost everything you did before.
What is the recurrence rate of bladder cancer after cystectomy? ›Local recurrence rate ranges between 30 and 54%. Distant recurrence is not often standardized and is reported in up to 50% of cases. The overall 5-year recurrence-free survival rates from 58 to 81%. The mean follow-up of studies included in the analysis ranged from 18 to 350 months.
What are the side effects of a cystectomy? ›- Bleeding.
- Blood clots in the legs.
- Blood clots that travel to the lungs or heart.
- Infection.
- Poor wound healing.
- Damage to nearby organs or tissues.
- Organ damage due to the body's overreaction to infection (sepsis)
Usually, surgery takes four to six hours.
Can you live a long life after bladder removal? ›Bladder removal (radical cystectomy) is an effective treatment for bladder cancer. A new study shows patients recover well from the surgery and have good quality of life.
Can you live a normal life after bladder removal? ›Yes, you can live without a bladder, but you'll need a new reservoir to hold pee that your kidneys produce. However, if a surgeon removes your entire bladder, there's an adjustment period as you become more comfortable with a new way to relieve yourself.
What are the complication rates of cystectomy? ›Radical cystectomy (RC) is a complex procedure requiring the urinary system's reconstruction. Reported rates of perioperative complications range from 27% to 73%, and operative time also varies widely according to factors such as patient age, tumor stage, need for lysis of adhesions, and type of urinary diversion.
How do you pee after a cystectomy? ›It connects to the newly created bladder so you can drain urine. You do this by placing a small plastic tube into your stoma. You decide when to do this. If you have a neobladder, you will have a thin plastic tube (catheter) coming out of your urethra for about 3 weeks.
Is a cystectomy painful? ›
After surgery, your belly will be sore. You will probably need pain medicine for 1 to 2 weeks. You can expect your urostomy (stoma) to be swollen and tender at first. This usually improves after 2 to 3 weeks.
What can you not do after bladder surgery? ›Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for about 3 weeks, or until your doctor says it is okay. For about 3 weeks, avoid lifting anything that would make you strain.
Does bladder cancer ever completely go away? ›These cancers can almost always be cured with treatment. During long-term follow-up care, more superficial cancers are often found in the bladder or in other parts of the urinary system. Although these new cancers do need to be treated, they rarely are deeply invasive or life threatening.
What are the second cancers after bladder cancer? ›Lung cancer (most common, accounts for about 1 out 4 second cancers in bladder cancer survivors) Vaginal cancer. Prostate cancer. Kidney cancer.
At what stage of bladder cancer is the bladder removed? ›Surgery as Primary Treatment
Radical cystectomy is considered a standard treatment for Stage III bladder cancer. A radical cystectomy involves removal of the bladder, tissue around the bladder, the prostate and seminal vesicles in men and the uterus, fallopian tubes, ovaries, anterior vaginal wall and urethra in women.
Late complications include ureteroileal anastomotic stricture, stomal stenosis, conduit stenosis, and urolithiasis. Although not directly related to ileal conduits, ureteroarterial fistula can occur in patients with an ileal conduit.
How do you pee after bladder removal? ›- a bag outside your body to collect urine (urostomy or ileal conduit)
- an internal pouch to collect urine (continent urinary diversion)
- a new bladder (bladder reconstruction or neobladder)
- a pouch made from your back passage (recto sigmoid pouch)
Is ovarian cystectomy a major surgery? It depends on what type of surgery you have. If your surgeon can perform the procedure laparoscopically, it's minimally invasive and you'll likely return to your typical activities within two or three weeks. There are still risks to surgery, but they're low.
How long are you down after bladder surgery? ›You will probably be able to go back to work in 1 to 2 weeks. But you will need at least 6 weeks to fully recover before returning to all normal activities. You must avoid heavy lifting and strenuous activities during this time. These might put extra pressure on your bladder while you recover.
What is the bowel prep for cystectomy? ›Beginning TWO (2) days before surgery, you may have clear liquids only. NO SOLID FOOD. Clear liquids include Jell-o, water (flavored or plain), tea, coffee, soda, chicken broth, clear fruit juices (apple, cranberry, white grade), Gatorade, carbonated beverages, plain water-ice, clear broth, bouillon, consommés.
What is the success rate of radical cystectomy? ›
| Characteristic | No. of cases | 5-year survival rate |
|---|---|---|
| Overall | ||
| Total group | 271 | 68.0% |
| Tumor grade | ||
| Low grade | 57 | 90.0% |
Risks and Benefits
A radical cystectomy is considered major surgery and at least 20% of patients have complications as a result, regardless of approach. Your doctor will discuss the risks and benefits of bladder removal surgery to treat your bladder cancer.
Urostomy pouches are special bags that are used to collect urine after some types of bladder surgery. Instead of going to your bladder, urine will go outside of your abdomen into the urostomy pouch. The surgery to do this is called a urostomy.
What is the diet for cystectomy? ›soups and stews are easy to digest, easier on the healing bowels and the easiest way to keep high nutrition for healing (try grating vegetables into soups or stews). For the first weeks, avoid fats and high-fibre foods, like popcorn and raw or undercooked vegetables.
Can you get UTI after cystectomy? ›Urinary tract infection (UTI) is a common complication following radical cystectomy (RC) with a rate ranging between 9.5% and 39%. It can significantly increase morbidity and readmission rates as well as the financial burden for both patients and the health care system.
Is cystectomy covered by insurance? ›For patients covered by health insurance, out-of-pocket costs for ovarian cyst removal typically would consist of a doctor visit copay and coinsurance of 10-50% or more. Ovarian cyst removal is typically covered by health insurance when medically necessary.
Can your bladder fall again after surgery? ›An organ can prolapse again after surgery. Surgery in one part of your pelvis can make a prolapse in another part worse. This may mean that you will need to have another surgery later. You might be able to relieve some symptoms on your own without surgery.
How long does it take for a bladder incision to heal? ›Most patients require a recovery period of 2-3 weeks at home before they feel ready for work. We recommend 3-4 weeks' rest before resuming any job, especially If it is physically strenuous and you should avoid any heavy lifting during this time.
How should I sleep after bladder surgery? ›Sleeping on your back
One of the best sleeping position after going through any surgery is resting straight on your back.
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Can you live 10 years with bladder cancer? ›
Survival for all stages of bladder cancer
almost 55 out of every 100 (almost 55%) survive their cancer for 5 years or more after they are diagnosed. around 45 out of every 100 (around 45%) survive their cancer for 10 years or more after diagnosis.
The initial treatment for this stage of bladder cancer is surgical removal of the tumor through a cystoscope, called transurethral resection of bladder tumor (TURBT). This is often followed by adjuvant (additional) therapy, which reduces the chances of the cancer recurring.
Where is the first place bladder cancer spreads? ›Where can bladder cancer spread to? Not all bladder cancers will spread. But If it does it's most likely to spread to the structures close to the bladder, such as the ureters, urethra, prostate, vagina, or into the pelvis.
What are the signs that bladder cancer has spread? ›...
Symptoms of bladder cancer
- a need to urinate on a more frequent basis.
- sudden urges to urinate.
- a burning sensation when passing urine.
Tell your doctor about any new symptoms, such as pain during urination, blood in the urine, frequent urination, an immediate need to urinate, and any other symptoms. These symptoms may be signs that the cancer has come back or signs of another medical condition.
Can bladder cancer come back after bladder is removed? ›Low-grade bladder cancers recur frequently, and recurrences require treatment with a procedure called transurethral resection for bladder tumor, or TURBT. Some patients experience multiple recurrences and, as a result, undergo repeated surgeries.
Does bladder cancer spread quickly? ›They tend to grow and spread slowly. High-grade bladder cancers look less like normal bladder cells. These cancers are more likely to grow and spread.
Do you need chemo after bladder removal? ›Chemotherapy after cystectomy — In some situations, chemotherapy is not given before cystectomy. However, for these people, chemotherapy may be recommended after surgery (called adjuvant chemotherapy) if more extensive disease is found when the bladder is removed.
Is bladder surgery considered major surgery? ›Bladder removal is a major surgery. This surgery can take anywhere between four and six hours, depending upon your prior surgical history, or maybe other intra-operative findings that we find during the operation.
How long does it take to heal from pain from cystectomy operation? ›After surgery, your belly will be sore. You will probably need pain medicine for 1 to 2 weeks. You can expect your urostomy (stoma) to be swollen and tender at first. This usually improves after 2 to 3 weeks.
Can you pee after a cystectomy? ›
Removing part of the bladder (partial cystectomy)
It is usually a treatment for a very rare type of cancer called adenocarcinoma of the bladder. After having a partial cystectomy, you can pass urine in the normal way. But your bladder will be smaller so you may need to go to the toilet more often.
General anesthesia. The procedure is usually performed under general anesthesia due to the length to complete the procedure, although epidural anesthesia with sedation is another option for open cystectomy and urinary diversion.
What replaces a bladder when removed? ›During neobladder surgery, a surgeon takes out the existing bladder and forms an internal pouch from part of the intestine. The pouch, called a neobladder, stores urine.
Is there an alternative to bladder removal? ›Trimodal chemoradiation – This is an alternative approach to removal of the bladder, in which a thorough, complete TURBT is performed and then followed with systemic chemotherapy and radiation therapy to the bladder.
Can you walk after bladder surgery? ›Many women are able to walk for 30 to 60 minutes after 3 to 4 weeks. It is common to experience fatigue after surgery. Having a daily lie down and resting with your feet up can help.
Is bladder surgery painful? ›Bladder sling surgery can cause mild to moderate pain, soreness, and general discomfort. In most cases, the pain is temporary and subsides over time. It may last a few days or, in some cases, a few weeks.
What is the survival rate of radical cystectomy with ileal conduit? ›Radical cystectomy with pelvic lymph node dissection provides the best cancer-specific survival for MIBC, with 10-year recurrence-free survival rates of 50%–59% and overall survival rates of approximately 45% (3,4).
How should I sleep after a cystectomy? ›Sleeping on your back: Supine support is the best way to sleep after the laparoscopic surgery. Place a pillow under the knees to relieve the pressure from your lower back. Put a neutral size pillow under your neck. Avoid too large pillow to avoid strain on the neck and back.
How do you sleep after a laparoscopic cystectomy? ›One of the best sleeping position after going through any surgery is resting straight on your back. If you have had surgery on your legs, hips, spine, and arms, this position will benefit you the most. Moreover, if you add a pillow underneath your body areas, it provides more support and comfort.