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Cystectomy

Cystectomy is the surgical removal of the entire bladder. This surgery may be suggested in certain cases of bladder cancer, especially high-grade, high-stage cancer. Your doctor can discuss the risks and benefits of cystectomy with you. If you decide to have surgery, the surgeon can explain the procedure and answer your questions.

Cutaway view of urinary tract
In men, the bladder, lymph nodes, prostate, and often the urethra are removed.

Preparing for Surgery

You’ll be given instructions on how to prepare for your surgery. These may include the following:

  • Your doctor may advise donating your own blood before surgery in case you need a transfusion during the procedure.

  • You may be given antibiotics to take before surgery to help prevent infection.

  • Don’t eat or drink anything after midnight the night before surgery.

  • You may be given a special drink to help clear out your intestine. In some cases, you may be admitted to the hospital the night before surgery and given medications and enemas to empty the intestine.

Image
In women, the bladder, uterus, cervix, lymph nodes, urethra, and sometimes part of the vagina are removed.

Removing the Bladder

The surgery is done in the hospital. It generally takes 4–6 hours, but can take longer depending on the situation. You’ll be given general anesthesia so you sleep throughout the procedure. An incision is made near your bellybutton. The area around your bladder is examined to see if the cancer has spread. If it has, the procedure may not be continued. If the cancer is only in the bladder, the bladder is removed. In case cancer cells have already spread, other organs near the bladder are often removed as well.

Risks and Possible Complications

  • Infection

  • Bleeding, requiring a transfusion

  • Blockage of intestine

  • Impotence

  • Blood clot

Creating a New Path for Urine

When the bladder is removed, another way to store and release urine is needed. This often means making a new opening for urine to travel out of the body. This procedure is called a urostomy.  The new opening, put near the belly button, is called a stoma.  A new urine path may be created in one of three ways:

  • In most cases, a piece of intestine is formed into a new bladder.  The new bladder is then reattached to the urethra, allowing urine to follow the usual path out of the body.  With this bladder, normal urination may then be possible during the day, although leakage may sometimes occur at night.

  • If a urostomy is needed, a piece of intestine may be removed and used to create a tube for urine to travel to the stoma.  A lightweight, leak proof bag is placed outside the body to collect the urine.  This bag is then emptied regularly.

  • In other cases, a piece of intestine may be formed into a pouch, which can store urine.  A catheter (soft rubber tube) is placed into the stoma at regular intervals to drain urine from the pouch.  No collection bag is needed. 

Neobladder

Common Types of Urostomies

These include:

  • An ileal conduit. This surgery makes a passage (conduit) from a segment of the ileum (last section of the small intestine). Urine leaves the body through this passage. One end of the conduit is sewn shut. The other end is brought through the abdominal wall to form a stoma. The ureters are detached from the bladder and connected to the conduit. Urine flows through the ureters and into the conduit. Urine then leaves the body through the stoma. This surgery does not change the way stool passes from the body. An ileal conduit is the most common type of urostomy.

  • A colon conduit. This surgery is done much like an ileal conduit. But with a colon conduit the passage is made from a piece of the colon and not the ileum. The resulting stoma is bigger, as the colon is wider than the ileum.

  • A ureterostomy. This surgery brings the ureters through the abdominal wall to form one or two stomas. In this case, the stoma or stomas are smaller. This is because the ureters are more slender than the ileum or the colon.

The Stoma

The stoma is an opening on the abdomen through which urine and mucus can pass. It is made by bringing the end of the ileum, the colon, or one or both ureters through the abdominal wall. This end is then turned back on itself, like a cuff.

  • The stoma is pink or red and moist. This is because the insides of the ileum, the colon, and the ureters are like the inside of the mouth.

  • The stoma shrinks to its final size 6 to 8 weeks after surgery. Then it will be round or oval. The stoma will either be flat or it will sit 1/4" to 1/2" above the skin.

  • With an ileal or a colon conduit, both urine and mucus pass through the stoma. After a ureterostomy, only urine goes through the stoma.

Recovery

You'll stay in the hospital for about a week or so before going home.  During this time, an enterostomal nurse (nurse specializing in ostomies) can show you how to use and care for your stoma if you have one.  If you have a pouch or new bladder, a catheter may remain in place to help drain urine for up to a month.  As you heal, your stoma is checked for problems.  Call your doctor if at any time during your recovery you have a fever, drainage from incision, swelling of your legs or feet, shortness of breath, or vomiting.

Follow-Up

You'll visit your doctor and enterostomal nurse every few weeks during your recovery.  These visits help make sure that your healing is on track and that your new urinary tract is working properly.  Every few months, tests are done to be sure you remain free of cancer.  These tests may include blood tests, chest x-rays, and sometimes imaging tests such as a CT scan. 

© 2000-2020 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.