Overview

Surgery is a common treatment option for bladder cancer. The type of surgery you have for bladder cancer typically depends on three things:

  • how advanced the cancer is
  • your overall health
  • if you’ve had bladder cancer before

Removing the bladder will affect your daily life, but you can make the process easier by being prepared before your surgery. Understand and strategize how to handle the lifestyle changes that will accompany the surgery. Prepare yourself for possible complications that may arise. These steps can help you and your loved ones plan for your new reality in the easiest way possible.

Causes

Bladder removal surgery is most often performed as a treatment for cancer. In some cases, you may need bladder removal surgery if another cancer is so advanced that it has spread to your bladder.

Some doctors may prefer to try a treatment option that is less invasive before surgery. However, advanced bladder cancer may require the removal of the entire bladder. This helps prevent the cancer from progressing and affecting other nearby organs or tissues.

Pre-operation

Cystectomy is the most common surgery used to treat bladder cancer. It may also be used to treat bladder cancer that has returned after previous cancer treatments.

There are two types used to treat bladder cancer:

  • Partial cystectomy: For bladder cancer that has advanced into the bladder wall in only one place, a partial bladder removal may be enough. This surgery is used if the cancer has not spread to the opening where urine exits.
  • Radical cystectomy: This type of surgery removes the entire bladder and nearby lymph nodes. In addition, the surgeon may also remove part of nearby organs where cancer may have spread.

If you’re having your bladder removed, doctors may remove additional organs or tissues based on your gender. Before you undergo the surgery, make sure you understand what your doctor will remove.

For men, the surgeon may also remove your:

  • prostate
  • part of the vas deferens
  • glands that secrete semen

If you’re a woman, the surgeon may also remove your:

  • ovaries
  • fallopian tubes
  • uterus
  • cervix
  • portions of the vagina

In addition, make sure you understand what your surgeon will do to allow for waste removal following the removal of your bladder. When your surgeon removes your bladder, they will make another way for urine to leave your body.

Two types of waste removal are typically used.

Incontinent diversion

For this option, your surgeon will use a portion of your intestine to create a tube. Instead of passing urine from the kidneys through your ureters to your bladder, this tube will pass urine from your ureters and into an opening in your stomach wall. From there, the urine will dump into a bag that is attached to your body.

Continent diversion

This waste removal option uses a section of your bowel to create a pouch inside your pelvis. How you choose to empty that pouch will determine which type of reservoir you use.

If all or a large portion of your urethra, the tube that brings urine from the bladder to the outside of the body, was removed during the surgery, your doctor can create a reservoir that collects urine in a pouch near an opening in your abdomen. You can then use a catheter, a thin plastic tube, to remove the urine from the pouch. This is known as continent diversion reservoir with stroma (urostomy).

If your urethra was not removed during the bladder removal surgery, the surgeon will connect the reservoir to your ureters at one end and to the remaining urethra at the other. Urinating will work much like it did before. This is known as bladder substitution reservoir (neobladder).

During the surgery

This surgery will require general anesthesia. In other words, you will be put to sleep while the surgical team performs the operation.

To perform this surgery, the surgeon will make a cut in your lower belly. The cut may be several inches long. This will allow space for the surgical team to properly access your bladder and the surrounding areas as needed.

In some cases, you may be able to have a laparoscopic surgery. This minimally invasive procedure makes several very small cuts in your abdomen. Through these cuts, doctors can access the area with their equipment without causing a lot of scarring.

Post-operation

You will likely remain in the hospital for three days to one week following the surgery. This period of time allows your doctor and the surgeon to analyze the new waste removal system. Your doctors will want to make sure it works properly and efficiently before you are released from the hospital.

The hospital staff and your doctor will work with you to understand how you will now remove urine from your body. If it requires any additional work on your part, the staff will train you and any caregivers on the best way to do this.

Long-term recovery

Once you leave the hospital, you will need several weeks of recovery. This recovery time allows your body to heal from the surgery. You may be able to perform light activities during this time. You should be able to resume normal activities in four to six weeks.

You will need to maintain constant care for your new urine removal structure. However, after a period of time, you will likely feel comfortable both with emptying your pouch or bag and urinating normally. It will take some time, but you’ll soon be accustomed to this new normal and find ways to make it fit into your life seamlessly.

Complications

The risks of bladder removal surgery are similar to other surgeries. The most common risks include:

  • reaction to anesthesia
  • bleeding
  • damage to adjacent organs and tissues
  • blood clots
  • an infection at the incision sites

Once the initial complications from the surgery pass, you may experience additional symptoms because of the new urine removal system your surgeon puts into place. These risks include:

  • infections
  • pouch stones
  • sexual problems, including erectile dysfunction and inability to have an orgasm
  • blocked urine flow
  • urine leaks
  • loss of sensation during intercourse

You can do several things after your surgery in order to stay on top of possible complications. These include:

  1. See your doctor regularly. Make appointments for check-ups with your doctor so that the two of you can stay in regular communication about how you’re feeling, how the waste removal structure is working, and any concerns you may have.
  2. Keep any openings cleaned. If you have an opening on your abdomen for waste removal, keep the area cleaned and sterilized. Only use sterile catheters to empty waste.
  3. Perform pelvic floor exercises. Help prevent urine leaks when performing tasks by strengthening your pelvic floor muscles. The easiest exercise requires you to sit on a chair or sturdy bench and squeeze your lower abdomen and pelvic muscles 10 to 15 times in a row, holding for one to two seconds each time. Try not to also tighten your buttock or stomach muscles while doing this. Repeat this exercise daily, and add more time to each squeeze to make it harder.

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