What is a cystectomy?

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.

How is this surgery done?

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.

What can you expect after this surgery?

A cystectomy usually requires a hospital stay of about a week. You will probably need 6 to 8 weeks to fully recover. If your surgery was done to treat bladder cancer, you may need other treatments after that. This may include chemotherapy or radiation therapy. Your doctor will set up a regular schedule of checkups and tests.

If just part of your bladder was removed, you will probably be able to pass urine as you did before the surgery. Your bladder may not hold as much urine for a while. You may need to pass urine more often at first. But later your bladder should adjust so it can hold more urine.

If all of your bladder was removed, you will need to learn how to care for your ileal conduit or continent reservoir. A wound ostomy continence nurse (WOCN) is trained to teach you how to do this.

Bladder cancer surgery may affect sexual function. If a woman's uterus and ovaries are removed during surgery, she will not be able to get pregnant. And she may start menopause. She may have hot flashes and other symptoms. And if a man's prostate gland and seminal vesicles are removed, he may have problems getting erections. And he will not be able to make a woman pregnant. If a man may want to father a child, he should talk to his doctor. It may be possible to save his sperm before the surgery.

You may feel sad or depressed. Or you may worry about how your body will look after surgery. You may worry about whether the surgery will affect your sex life. These concerns are common. Call the Canadian Cancer Society (1-888-939-3333) or visit its website at www.cancer.ca to learn more.