If a bladder tumor invades the muscle wall or if CIS or a T1 tumor still persists after BCG therapy, the urologist may suggest removal of the bladder or a radical cystectomy. Before any radical surgery is performed, a series of CT scans or an MRI will be ordered to exclude the possibility of metastatic or “distant” disease in other parts of the body. If the patient has metastatic disease, surgery to remove the bladder is not recommended and patients will be referred to a medical oncologist to discuss chemotherapy. The two types of surgery performed for muscle-invasive bladder cancer are partial or complete radical cystectomy.
Partial cystectomy is fairly uncommon and is only performed:
- if the muscle-invasive bladder tumor is the first and only bladder tumor the patient has had and
- if the tumor is in a location where it is easily accessible for surgery and, if removed, will leave the bladder with enough capacity for the patient to have normal bladder function.
A complete radical cystectomy requires complete bladder removal, and in men, almost always involves removal of the prostate as well. For women, in addition to removing the bladder, the surgeon may also remove the uterus, fallopian tubes, ovaries and cervix, and occasionally a portion of the vaginal wall. In addition, the surgeon will remove lymph nodes surrounding the bladder, and perhaps even more, to determine whether the cancer has progressed to the lymph nodes, which then could result in metastasis. The lymph node removal is an important method of accurately staging the progression of the disease. Cystectomy can be performed through an open incision or laparoscopically, typically with robotic assistance. Removal of the bladder also requires the surgeon to create a passage for the urine to go from the kidney to outside the body. Even though the bladder is removed, the kidneys, ureters and urethra are still in place. Because no artificial bladder has yet been invented that is tolerated by the urinary tract system, the urologist has learned to create the passageway or conduit between the kidneys and ureters and the urethra using a piece of the patient’s own intestine.
Click here to read our Get the Facts | Radical Cystectomy (PDF), filled with advice from patients who have experienced it.
Watch Life after Bladder Removal – Selecting your best urinary diversion presented by Alexander Kutikov from Fox Chase Cancer Center to learn more.
What are the types of urinary reconstructions available if I need to have my bladder removed?
The easiest and most common reconstruction performed by the urologist. A small portion of the ileum or small intestine is disconnected. One side of the piece of ileum is attached to a skin opening on the right side of the abdomen and a small stoma or mouth is created. A plastic appliance or ostomy bag is placed over the stoma to collect the urine. The ureters are sewn or re-implanted near the other end of the ileum. Because the nerves and the blood supply are preserved, the conduit is able to propel the urine into the appliance.
Click here to read our Get the Facts | Ileal Conduit (PDF), filled with advice from patients who have experienced it.
Continent cutaneous pouch (CCP)
An internal storage “container” for urine. Using a combination of small and large intestine, the urologist reconstructs the tubular shape of the intestine and creates a sphere or pouch. This pouch is connected to the skin on the abdomen by a small stoma creating a type of continent urinary reservoir; no external bag is necessary. The patient drains the pouch periodically by inserting a catheter (a thin tube) through the small stoma and then removing the catheter and, in some cases, covering the stoma with a bandage.
Click here to read our Get the Facts | CCP(PDF), filled with advice from patients who have experienced it.
Read some practical questions & answers from Karen, a bladder cancer survivor living with a CCP.
A type of internal reservoir for storing urine. Using a portion of small intestine, the urologist reconstructs the tubular shape of the intestine and creates a sphere. The surgeon then connects the pouch to the urethra, creating a neobladder, in which case the patient can void (pass urine out of the body) normally. By tensing the abdominal muscles and relaxing certain pelvic muscles, the patient is able to push the urine through the urethra.
Click here to read our Get the Facts | Neobladder (PDF), filled with advice from patients who have experienced it.
Read some practical questions and answers from Michael, a bladder cancer survivor living with a neobladder.
A radical cystectomy is considered major surgery and at least 20% of patients have complications as a result, regardless of approach. The choice of which type of reconstruction to utilize is a highly-individualized decision between the patient and the doctor, and depends on a variety of factors, including the patient’s overall health, age, and extent of disease. There are advantages and disadvantages to each type of reconstruction.
Watch BCAN’s “The New Normal: Living with a Urinary Diversion” video series profiling eight bladder cancer survivors discussing their urinary diversion choice and sharing their experience to let others know about living well with a urinary diversion.
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