Bladder cancer surgery
Bladder cancer almost always requires some type of surgery.
When deciding which type of surgery is best for you, it’s important to consider how far the cancer has spread. Some types of surgery are good for early-stage bladder cancer, while more advanced cancers require different procedures.
Your surgeon will work with you to choose the best options based on your overall health and personal preferences.
Types of surgery
Surgical options for bladder cancer include:
Transurethral resection of bladder tumor (TURBT)
This surgery has two purposes. It can be used to confirm the diagnosis of bladder cancer and to see if the muscle layer of the bladder wall has been breached.
In addition, it’s used to treat early-stage bladder cancer, when the cancer has not grown outside the inner layers of the bladder.
TURBT is performed under general or regional anesthesia, but it doesn’t require an abdominal incision. The surgeon accesses the bladder through the urethra with an instrument called a cystoscope.
A wire loop is passed through the cystoscope and into your bladder. The loop is used to remove abnormal tissue or tumors. Samples can then be sent to a pathologist for examination. Using an electric current or high-energy laser, the remaining cancer cells are burned and destroyed.
Most people can go home the day of surgery or the following day. Side effects from TURBT may include bloody urine or pain during urination. These symptoms usually last only a few days. You should be able to get back to your normal schedule in two weeks.
Bladder cancer has a tendency to come back in another part of the bladder. The procedure can be repeated as often as needed. Side effects of repeat TURBT may include scarring of the bladder, which can cause problems controlling urination.
If you have recurrent tumors that are non-invasive and slow growing, your doctor can choose to burn them rather than remove them with surgery. It’s a simpler procedure and may prevent excessive scarring.
Partial cystectomy (segmental cystectomy)
If TURBT isn’t an option because cancer has invaded the bladder wall, a partial cystectomy can be performed. This procedure removes the part of the bladder that has cancerous cells. It’s not an option if losing that portion of the bladder would interfere with bladder function, or if cancer is found in multiple areas of the bladder.
Your surgeon may also remove nearby lymph nodes to determine if the cancer is spreading. The benefit of partial cystectomy is that it allows you to keep your bladder.
Because your bladder will be smaller, it won’t be able to hold as much. That means more frequent trips to the bathroom.
Radical cystectomy and reconstructive surgery
If the cancer has invaded the bladder wall or you have tumors in multiple locations within the bladder, you may need a radical cystectomy. It’s a procedure to remove the bladder and nearby lymph nodes. Because there’s a possibility the cancer has spread, other organs are removed as well.
In women, this often means removing the:
- fallopian tubes
- part of the vagina
In men, it may mean removing the prostate and seminal vesicles.
The procedure is done under general anesthesia and involves an abdominal incision. It can also be done laparoscopically with the aid of robotic instruments.
Once your bladder and other organs are removed, your surgeon will create a new way for you to urinate. There are a few ways to do this:
- Incontinent diversion: A piece of your intestine can be used to make a tube that runs directly from the ureters to a pouch outside your abdomen (urostomy bag).
- Continent diversion: A piece of intestine is used to make a pouch, which is connected to an opening in the skin on your abdomen. Using a catheter, you will drain the pouch several times a day. There’s no need to have a bag outside your body.
- Neobladder: In this procedure, the surgeon makes a new bladder out of intestine. The neobladder is attached to the urethra, allowing you to urinate. It may take a few months to be fully functional, and you may still occasionally need a catheter or have incontinence during the night.
You might have to stay in the hospital for up to a week following surgery. It will take several more weeks before you can resume some normal activities.
These are major surgical procedures and they do carry risks of complications or side effects, including:
- bleeding or blood clots
- damage to nearby organs
- urine leakage or blocked urine flow
- sexual problems
Following this surgery, men are still able to orgasm, but cannot ejaculate. Some will have erectile dysfunction.
Women will experience infertility and premature menopause. It may take months of healing before sexual intercourse without pain is possible.
In cases where cancer is very advanced and the bladder can’t be removed, surgery can be used to divert urine and relieve urinary obstruction.
What will recovery be like?
Your healthcare team will encourage you to sit up and walk around soon after surgery. You’ll probably also have pain medication or antibiotics during your hospital stay and for a time after you go home.
Follow your doctor’s recommendations and keep follow-up appointments. Seek medical attention if you have:
- pain or swelling of the legs
- sudden chest pain
- shortness of breath
- swelling and growing redness at the incision site
- nausea or vomiting
- dark or foul smelling urine, or decreased urine output
You may have tubes or drains hanging outside your body for several weeks while you heal. Your doctor will remove them at the appropriate time.
You may need additional treatment after surgery, including:
- Immunotherapy: These are treatments that help your immune system destroy cancer cells. For early stage bladder cancer after TURBT, sometimes drugs are inserted into your bladder via a urethra catheter. Side effects include flu-like symptoms.
- Chemotherapy: This systemic treatment kills cancer cells wherever they are in your body. The drugs are usually administered intravenously, but can also be given via catheter directly into the bladder. Side effects may include nausea, loss of appetite, and fatigue.
- Radiation therapy: High-energy beams are used to kill cancer cells. Side effects include skin irritation and fatigue.
These treatments may be used alone or in combination.
Much depends on the stage at diagnosis and the tumor grade. Your overall health, age, and how well you respond to treatment also play a role. Using that information, your doctor will be able to give you some idea what to expect.
Generally, people with low-grade bladder cancers do very well. The cancer rarely spreads to the bladder wall or beyond. High-grade tumors tend to spread faster and recur after treatment.
Since it’s not uncommon for bladder cancer to return, you must continue to see your doctor regularly. You may need other treatments for months following surgery.
If you have a radical cystectomy, there will be a period of adjustment. You can get more information and support from these organizations:
Preparing for surgery
It’s a good idea to bring someone with you when you visit your doctor before surgery, and it’s even better if they agree to take notes for you.
- Write down your questions in advance so you won’t forget.
- Get your post-op visit on the calendar as well so you don’t have to worry about scheduling it after your surgery.
- Tell your doctor about any other health conditions. List any over-the-counter or prescription medications or supplements you take.
Your healthcare team will provide you with detailed instructions on how to prepare for surgery, including bowel prep.
Ask your doctor when you can expect pathology results after surgery, and what other treatments may be needed.
Make sure you have comfortable, loose-fitting clothes to wear for a few weeks after surgery.
Recovery can take some time, so arrange to have someone around to help with daily chores and errands in the weeks following surgery.