Bladder Removal (Cystectomy)
Patients with bladder cancer may need to have a type of surgery called a cystectomy.1-3 During a cystectomy, a surgeon removes all or part of the patient’s bladder. Bladder cancer cells typically start to grow in the thin layer of cells that line the inside of the bladder. In muscle-invasive bladder cancer, the cancer cells have grown into the muscle layer of the bladder wall. The cancer cells may also have spread to organs or lymph nodes near the bladder. Cystectomies are usually not used to treat patients who have metastatic bladder cancer that has spread to areas of the body distant from the bladder.
There are two types of cystectomy surgeries for treating patients with bladder cancer: radical cystectomy and partial cystectomy.
When does a person need a radical cystectomy?
Patients who have bladder cancer tumors that are large or are located in more than one part of the bladder may need to have a radical cystectomy as part of their treatment.1-3 The surgery may also be recommended for patients with bladder cancer that has not grown into the bladder muscle, but the tumor has not responded to initial therapy.
What happens during a radical cystectomy?
During a radical cystectomy, the surgeon typically removes the patient’s entire bladder, part of the ureters (the thin tube-like organs that connect the bladder to the kidneys), and the lymph nodes that surround the bladder. After the surgery, the lymph nodes removed by the surgeon will likely be sent to a laboratory for analysis to help stage the patient’s cancer.
Other organs may be removed during a cystectomy
In male patients, the surgeon usually removes the prostate and seminal vesicles in addition to the bladder, parts of the ureters, and lymph nodes. In female patients, the surgeon may also remove the uterus, ovaries, fallopian tubes, cervix, and sometimes part of the vagina.
Creating a new way to store and pass urine
What is a partial cystectomy?
A partial cystectomy is surgery to remove a part of the bladder rather than the entire organ.1-3 Partial cystectomies are much less common than radical cystectomies for treating patients with bladder cancer. It is generally only used to treat a patient who has bladder cancer that involves only one tumor. For this type of surgery, the tumor also needs to be located in an area of the bladder where the surgeon is able to remove part of the bladder wall while still leaving enough of the bladder intact for it to store and pass urine. The surgeon also typically removes lymph nodes near the bladder that can be analyzed in the lab to help stage the patient’s cancer.
The advantage of a partial cystectomy is that the patient does not need to have reconstructive surgery to create a new way for the body to store urine. However, because the bladder is smaller after surgery, it may not be able to hold very much urine, so the patient may need to urinate more frequently after surgery.
How are cystectomies performed?
Patients are put under general anesthesia during a cystectomy procedure.1,2 A surgeon can perform a cystectomy in two different ways. It can be performed using a single open incision in the lower part of the abdomen, or it can be performed using a type of robot-assisted laparoscopic surgery. During laparoscopic surgery, the surgeon makes several smaller incisions in the abdomen and uses special thin surgical instruments, including a tiny camera, that allow the surgeon to potentially perform the surgery using a computer console and robotic surgical tools. Patients who have laparoscopic surgery may have quicker recovery times than patients who have surgery through a single open incision.
Risks of bladder removal surgery
Like any major surgery, there are some risks associated with cystectomies, such as infections, bleeding, and reactions to anesthesia. Some men experience erectile dysfunction after surgery and women can also experience sexual dysfunction after surgery. In women, removal of the ovaries causes infertility and menopause. However, there are ways to potentially help avoid and/or treat these effects in many patients.