What is cystectomy?

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.

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.

Complications are common after a radical cystectomy. They may include short-term and longer-term problems.

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).

A cystectomy is surgery to remove part or all of the bladder. It is mainly used to treat bladder cancer.

There are three types of surgery.

• Partial cystectomy takes out part of the bladder.
• Simple cystectomy takes out all of the bladder.
• Radical cystectomy takes out all of the bladder. It also takes out nearby lymph nodes and all or part of the urethra. That's the tube that carries urine from your bladder and out of your body. Nearby organs that may have cancer cells are removed as well. This may include the prostate and seminal vesicles in men. And it may include the uterus and ovaries in women.

A cystectomy usually requires a hospital stay of about a week. You can expect some discomfort during the first few days after surgery. This discomfort can often be controlled with home treatment and medicine. Complete recovery usually takes 6 to 8 weeks.

If you were treated for cancer, more treatment may be needed after a radical cystectomy. This may include radiation therapy or chemotherapy. Immunotherapy may be used after a partial cystectomy for early-stage tumors.

After your treatment for bladder cancer, it's important to receive follow-up care. Your doctor will set up a regular schedule of checkups and tests.

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

If you have a simple cystectomy or radical cystectomy, your doctor will create a new way for you to pass urine. There are a few ways this can be done.

• An ileal conduit uses a piece of your small intestine to make a tube. The doctor connects one end of the tube to an opening he or she makes in your belly. The other end of the tube attaches to your ureters. Those are the two tubes that carry urine from the kidneys to the bladder. After surgery, the urine will pass from the ureters through the tube. Then it goes out the opening into a plastic bag. The bag is attached to your skin.
• A continent reservoir uses a piece of your bowel to make a storage pouch. It is attached inside your pelvis. There are two types of storage pouches. Both types let you control when you pass urine. You may have a:
  • Bladder substitution reservoir. (This may be called a neobladder.) If your urethra was not removed, the storage pouch will attach to your ureters at one end and to your urethra at the other. This lets you pass urine much like you did before surgery.
  • Continent diversion reservoir with stoma. (This may be called a urostomy.) If all or part of your urethra was removed, the storage pouch will connect your ureters to an opening the doctor makes in your belly. You will put a thin plastic tube called a catheter through the opening to let out the urine.

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.