Cystectomy is a big operation to remove the bladder, usually only recommended for ‘muscle invasive’ bladder cancer. However, it is also considered in patients who have high grade superficial disease, particularly if the cancer hasn’t been responsive to other treatments.
Radical Cystectomy FAQs
How is a cystectomy performed?
A cystectomy if performed under a general anaesthetic (fully asleep). You will probably also have an injection in the back (epidural) to help with pain after the operation. A cut is made from the umbilicus (belly button) to just above the pubic bone.
The whole bladder is removed, although in certain rare forms of bladder cancer a ‘partial’ cystectomy can be offered. In a man, the prostate is usually removed at the same time. In a woman, it is often necessary to remove the uterus (womb). The ureter tubes that drain urine from the kidneys have to be disconnected from the bladder when it is removed.
What happens to the urine when the bladder is removed?
There are two main options. The most common is called an ileal conduit. Here a section of the intestine is disconnected from the rest of the bowel and used to carry urine from the ureter tubes up to the skin of the abdomen (a stoma). The urine is collected in a bag worn on the skin.
Alternatively, a section of intestine can be made into a reservoir called a neobladder that can collect and store the urine. The patient can then either use a catheter to drain the urine when it is full, or sometimes pass urine naturally. This means that a bag does not need to be worn, but the operation is significantly more challenging an ileal conduit and some people are more prone to problems with this method, such as urine leakage or infections.
What happens after the cystectomy?
Most patients stay in hospital for at least a week. You may not feel able to eat for several days after surgery and will need a drip. You will have some wound drains, and these are removed after a few days once the surgeon is happy. After a few days, the nurses will show you how to look after your bag (if you have one).
As it is such a big operation, there are a number of potential complications:
- Bleeding, which might need a blood transfusion
- Wound infection or breakdown of the wound
- Clots in the leg veins or even a clot on the lung (pulmonary embolism)
- Heart problems, including a heart attack (especially if you have a heart condition)
- Chest infections
- Leakage of urine from where the ureter pipes have been connected u
- Leakage from the bowel into the abdomen
- Hernia formation
- Problems with the bags or stoma
Because there are many serious complications from this type of surgery, you should take every precaution to help minimise the risk of them happening. Studies have shown that one of the most important factors in preventing complication is the level of experience of the surgeon and his or her level of expertise. In Nottingham, all such operations are undertaken by a team led by Mr Will Green, who runs the bladder cancer service at Nottingham University Hospitals.