What Is Cystectomy?
A cystectomy is a surgery to remove your bladder. The bladder can stretch or relax to hold about 2 cups of urine (pee). Cystectomy often treats bladder cancer. But bladder removal surgery can help other bladder problems, too.
After cystectomy, your urine may need a new route to exit your body (urinary diversion). Your surgeon can create a new tube for you to urinate from.
Can you live without a bladder?
You can actually live without your bladder. Your surgeon makes a new urine channel for your pee to come out.
“There are several options for creating this new channel — all of which [use] the small or large intestine,” says Paul L. Crispen, MD, a cancer specialist (oncologist) and urologist at University of Florida Health in Gainesville, Florida. “Following bladder removal, there’s an adjustment period as you [get used] to life without a bladder.”
As you heal, it’ll get easier to live without a bladder. Your body adjusts to the new way you’ll pee. And most people get back to normal, says Crispen.
Who May Need a Cystectomy?
A cystectomy commonly treats bladder cancer. Your bladder may be removed if you have:
- Cancer in the muscle wall of your bladder
- Cancer in the bladder lining (non-muscle invasive) and treatment isn't working
- Higher risk for or recurrent (comes back) bladder cancer
- Other bladder cancer problems like bleeding or injury from radiation therapy
Cystectomy can treat benign (not cancer) bladder conditions, too. Bladder removal may be an option if you have:
- Painful bladder problems (interstitial cystitis)
- Nervous system damage causing bladder problems (neurogenic bladder)
- Chronic pain, bleeding, and inflammation (hemorrhagic cystitis)
- Infections in your bladder
- Endometriosis
- Bladder fistula (small hole connects your bladder to another organ)
- Bladder problems at birth (congenital)
Crispen says many bladder conditions benefit from cystectomy.
Types of Cystectomy
You can get part or all of your bladder removed. Your type of cystectomy can depend on your medical condition.
With bladder cancer, radical cystectomy is common. For other bladder problems, you may be able to keep part of your bladder.
Partial cystectomy
If other treatments don't work, partial cystectomy may be an option. This surgery removes only the parts of your bladder not working.
You'll still have a pouch to collect pee. But your bladder is smaller. Partial cystectomy isn't common. Only 5 in 100 people get a cystectomy because of bloody urine from radiation therapy.
For bladder cancer, your doctor may also remove nearby lymph nodes.
Simple cystectomy
A simple cystectomy removes your bladder but nothing else. You may need a simple cystectomy if you:
- Lose bladder control because of brain, spinal cord, or nerve problems (neurogenic bladder)
- Get radiation cystitis where radiation therapy inflames the lining of your bladder
- Have a hole (urinary fistula) connecting your bladder to another organ
- Get interstitial cystitis causing bladder pressure and pain --- sometimes pelvic pain, too
Radical cystectomy
A radical cystectomy takes out all of your bladder, nearby organs, and tissues, too. About 12 in 100 people get a radical cystectomy for bladder cancer. Sensitive nerves near your bladder can get damaged. And you can have a higher risk for sexual dysfunction.
You can have problems with erection (impotence). But your surgeon uses special methods to lower your risk. If you have a penis, your surgeon may remove your:
- Bladder
- Urethra (some parts)
- Nearby lymph nodes
- Prostate gland
- Seminal vesicles (glands making fluid for semen)
- Vas deferens (long tube carrying sperm)
After cystectomy, about 31% to 50% of people can still get an erection.
If you have a vagina, a radical cystectomy can cause problems with vaginal lubrication. Your surgeon may take out your:
- Bladder
- Urethra, the upper and lower parts
- Nearby lymph nodes
- Vagina
- Uterus (womb) and cervix
- Ovaries
With a breast or ovarian cancer history, they may remove your fallopian tubes (carry the egg to your womb), too. If possible, your surgeon keeps your vagina, uterus, and ovaries. Talk about what’s best for your health with your doctor.
Cystectomy Procedure
A cystectomy is a major surgery removing your bladder. You can get open, minimally invasive, or robotic surgery. The procedure takes about three to six hours.
Before a cystectomy
You’ll meet with your surgeon and nurse. They'll look at your belly to find the best place for your stoma. Your stoma is the opening for your pee to come out.
Try out a sample urine bag. It can help you decide on the best bag type. You’ll want to make sure it’s flat against your body. See if it's comfortable, too. Ask about how the bag can affect your hobbies or activities later on.
Day of your cystectomy
You’ll meet your urologist; they'll do your surgery. They treat the bladder and urine system. You'll also meet your anesthesiologist. This doctor gives you medicine to put you asleep.
You won't feel any pain during the surgery. Your doctor may also give you antibiotics to help prevent infection before surgery.
How is a cystectomy performed?
After you're asleep, your surgeon makes a cut in your abdomen (belly). They'll puff air into your belly. The air creates room for your surgeon to work.
In robotic-assisted surgery, a camera helps guide long thin tools into your body. Robotic-assisted procedures help lower your risk for pain, blood loss, and incisions. You'll likely recover faster and have a shorter hospital stay, too.
In open surgery, you'll get a 6- to 7-inch cut. The bigger cut helps your surgeon reach your bladder. They'll make it between your belly button and pubic bone. Wearing surgical gloves, they use their hands to operate.
“During the surgery, the bladder is separated from tubes that drain urine into the bladder, and the urethra,” says Crispen.
Your surgeon can take a tissue sample to test for cancer cells (biopsy). But they'll save as many organs and nerves as possible. Most often, your urine needs a new path to exit your body (urinary diversion).
Urinary diversion
You'll get a new channel for urine to come out or a new sac to hold pee. Here are a few ways for this to happen:
Cystectomy with ileal conduit. A new tube is made from your ileum (small intestine). It's a common way to reroute your pee after bladder removal surgery.
Your surgeon connects a short piece of your ileum to the ureters. Your ureters (tubes) carry pee from your kidneys to your bladder. Then, they sew this new channel to a small opening in your belly (stoma). Your pee drains out of the opening (urostomy) into a plastic bag.
Continent cutaneous diversion. Your surgeon makes a pouch from a section of your bowel (intestines). The new pouch stores your pee inside of your body.
But you'll still have a stoma that connects to your urine pouch. You'll drain your pee out of the opening using a catheter every four to six hours.
Neobladder. If you have a urethra, your surgeon can make a new bladder (neobladder). The urethra is a tube carrying pee out of your body. They'll use part of your intestines to form a new pouch. Your surgeon puts it where your bladder was before.
Next, your surgeon connects the neobladder to your urethra. You pee in the same way as you did before. Sometimes, you may need a catheter to get all your pee out.
Ureterosigmoidostomy. This surgery connects your ureters to the last part of your large intestine (sigmoid colon). The urine leaves your body with your stool (poop). This procedure isn't common because it can raise your risk for kidney infections and colon cancer.
Cystectomy Recovery
After surgery, anesthesia side effects can cause a sore throat, dry mouth, nausea, or vomiting. You can shiver or feel sleepy, too. Your health care team can give you medicines to help.
You'll probably stand up and walk several times a day after surgery. Walking can help prevent blood clots and raise blood flow. It also helps you heal and keeps your bowels moving.
You’ll likely be in the hospital for five to seven days. But open surgery and some health conditions can take longer. Your health care team will tell you how to take care of your cuts (incisions). They'll teach you how to clean your stoma, too.
You'll learn to care for any new devices to help you pee. Complete recovery may take several weeks to months. Here are a few tips to help you recover:
Drink water. Stay hydrated after surgery. You can also try oral rehydration solution (ORS) or pediatric oral rehydration solution. These drinks can help your body get the right amount of electrolytes.
Keep your bowels moving. With cystectomy, you're at risk for ileus. That means your stomach muscles can stop or slow down. Gas, air, and fluid can build up. Drink fluids and go for light walks. Walking and light activity can help your bowels move.
Get sleep. Rest if you feel tired. Give yourself time to heal. And make sleep a priority. It can help you recover.
Go for light walks. Slowly take regular walks. Start small and add a few steps each day. Walking can boost your energy and help prevent infection, too. Ask your doctor about starting activity after your surgery.
Bowel habits. Your bowels can be constipated or watery (diarrhea) after cystectomy. If your stomach gets upset, try bland foods. You can eat rice, broiled chicken, or toast. If you're constipated, try a fiber supplement or the prescribed laxative. And drink plenty of fluids.
Use a pillow. After your surgery, you may be sore for a few weeks. Coughing or sneezing can be painful. Try gently holding a pillow over your cuts. It can help ease the soreness.
Get support. Think about talking to someone who’s had a cystectomy. Sharing your thoughts can help. And others can help you know what to expect, too. Ask your provider about local groups. You can also find support at the United Ostomy Association of America.
Bladder Removal Surgery Risks
Most people have pain after the surgery. Your doctor will likely give you medicine, but you'll get better as you heal. Every surgery comes with risks and cystectomy can have higher ones, says Crispen.
“Like other abdominal surgeries, there is the risk of bleeding, infection, wound complications, and injury to surrounding organs,” says Crispen. “Additionally, bladder removal surgery can impact sexual function and other quality-of-life measures.”
Bladder removal surgery can also raise your risk for:
- Infections like sepsis (serious infection that can damage organs)
- Blood clots in your legs or lungs
- Rarely, death from surgery complications
For partial cystectomy, you may not hold as much urine as before. And for a radical cystectomy, side effects depend on the organs taken out. You may have:
- Constipation or chronic diarrhea
- Urinary tract infections
- Slower bowels (ileus)
- Loss of bladder control (urine leaks or incontinence)
- Pouch stones (like bladder stones)
- Blocked urine (ureter blockage)
- Mineral or vitamin problems (don't absorb nutrients like vitamin B12)
- Lower kidney function
If your prostate and seminal vesicles are removed, you may stop making semen. This is normal after radical cystectomy. You can still have an orgasm, but it may be "dry."
If nerves get damaged, you can have sexual dysfunction. This can mean problems with erection or vaginal lubrication. As you heal, these issues may get better. But sometimes, you can't orgasm. If this happens, your vagina can be rebuilt.
When should I call the doctor?
Contact your doctor or provider if your:
- Pain gets worse
- Stitches come open
- Incisions bleed, drain pus, get infected (red streaks, fever, or swell)
- Urine doesn't drain into urostomy pouch
- Bladder gets infected (pain, blood in urine, fever)
- Stomach gets sick or can't drink fluids
Call your doctor or get medical help right away if you:
- Pass out
- Have chest pain
- Get short of breath
- Cough up blood
- Have signs of a blood clot (pain, redness, or swelling)
Questions for Your Doctor
Prepare for your cystectomy and bring a list of questions to your doctor’s appointment. The questions can help you know what to expect.
You may ask:
- What is the goal of my surgery?
- How long will my surgery take?
- How should I get ready for surgery?
- How long should I expect my recovery to take?
- How will I pee after my surgery?
- Will I need to learn how to use a device or bag to pee into after surgery?
- When can I start normal activity after my surgery?
- Will I need to stay on a special diet after cystectomy?
- How many cystectomies have you done in the past?
- Is this my only option to treat my problem?
Alternatives to Cystectomy
Cystectomy isn't right for everyone. And bladder removal surgery can raise your risk for other problems.
Here are other treatments that try to spare your bladder:
Intravesical immunotherapy puts medicine directly into your bladder. Immunotherapy activates your immune system to kill bladder cancer cells.
Trimodal therapy (TMT) removes the bladder tumor followed by chemotherapy and radiation treatments.
TMT combines surgery with targeted therapies. Immune checkpoint inhibitors and antibody-drug conjugates use antibodies to target and kill cancer cells.
“Select patients with bladder cancer may be offered combined radiation and chemotherapy in an attempt to leave the bladder in place,” says Crispen. Sparing your bladder may raise your quality of life. But it can also raise your risk for bladder cancer to recur. Talk with your urologist to find out your best treatment for your health.
Takeaways
A cystectomy removes part or all of your bladder and other organs, too. Commonly used to treat bladder cancer, cystectomy can reroute urine through a small hole in your belly (stoma). Urinary diversion makes a new channel or pouch from your bowels for pee to exit your body. Most people recover after a few months, but other alternatives can help spare your bladder.
Cystectomy FAQs
Is a cystectomy major surgery?
Cystectomy is a complex, major surgery. Bladder removal surgery opens major body cavities. Even minimally invasive procedures remove major structures from your body. Give yourself plenty of time to heal and adjust.
Does cystectomy cure bladder cancer?
A cystectomy doesn’t always cure bladder cancer. But a radical cystectomy is often the best chance for a long-term cure. About 64 in 100 people live five years after radical cystectomy to remove muscle invasive bladder cancer.
How long can you live after a cystectomy?
Everyone's health is unique and can play a role in how long you live after a cystectomy. Factors like your age, medical conditions, and stage of cancer matter, too. Better therapies and finding cancer earlier gives you the best chance for a cure. Here are some general numbers after cystectomy:
- Overall, about 78 in 100 people live five years.
- If the cancer is local, about 72 in 100 people live five years.
- If the cancer isn't outside of the region, about 40 in 100 people live five years.
