Most people with muscle-invasive disease have surgery to remove the bladder (cystectomy). This may also be recommended for cancer in the lamina propria that has not responded to BCG.
The surgeon usually needs to remove the whole bladder. This is called a radical cystectomy.
Less commonly, it may be possible to do a partial cystectomy. This removes only the tumour and a border of healthy tissue. The bladder will be smaller, so you may need to pass urine more often.
Learn more about:
- Surgery to remove the bladder
- How the surgery is done
- What to expect after surgery
- Side effects of cystectomy
Surgery to remove the bladder
The most common operation for muscle-invasive bladder cancer is a radical cystectomy. The surgeon removes the whole bladder and nearby lymph nodes. Other organs may also be removed.
Cystectomy in males
Cystectomy in females
|Because a radical cystectomy removes the whole bladder, the surgeon needs to create a new way for your body to collect and store urine. This is called urinary diversion.|
How the surgery is done
Surgery to remove the bladder (cystectomy) is a major and complicated operation. It is important to have this surgery in a specialised centre with a surgeon who does a lot of cystectomies.
Different surgical methods may be used for removing the bladder. Open surgery makes one long cut (incision). Keyhole surgery, also known as minimally invasive or laparoscopic surgery, uses several smaller cuts, sometimes with help from a robotic system. Recovery may be faster and the hospital stay may be shorter with keyhole surgery, but open surgery is recommended in some situations. In general, having a very experienced surgeon is more important than the type of surgery.
Talk to your surgeon about the pros and cons of each approach, and check what you’ll have to pay. Unless you are treated as a public patient in a hospital or treatment centre that offers this surgery at no extra cost, cystectomy can be an expensive operation.
What to expect after surgery
After a radical cystectomy, you will probably stay in hospital for 1–2 weeks. You will have tubes in your body to give you fluids and to drain fluids from the operation area. It’s common to have pain after the surgery, so you may need pain relief for a few days.
A cystectomy will affect how you store urine and urinate, and it can also affect sexuality and fertility in various ways. These can be major changes. For more on this, see Managing changes after treatment.
|Physiotherapy before and after treatment|
Ask your doctors if you can see a physiotherapist before and after treatment for bladder cancer. The physiotherapist can teach you exercises to strengthen your pelvic floor muscles, which help control bladder and bowel function. These exercises can be important if you are having a radical cystectomy with a neobladder, a partial cystectomy, or radiation therapy to the bladder area.
Side effects of cystectomy
Effects on urination
If you have a partial cystectomy, your bladder will be smaller and hold less urine, so you may need to pass urine more often. If you have a radical cystectomy, you will need to collect and store urine in another way. This is called urinary diversion – learn more about this procedure.
Effects on sexuality
In men, the nerves needed for an erection are likely to be affected. Women who have their reproductive organs removed will go through menopause if they have not already. These changes may affect your fertility and how you feel about your sex life – for more information, see Sexuality and fertility after cystectomy.
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Prof Dickon Hayne, UWA Medical School, The University of Western Australia, and Head, Urology, South Metropolitan Health Service, WA; BEAT Bladder Cancer Australia; Dr Anne Capp, Senior Staff Specialist, Radiation Oncology, Calvary Mater Newcastle, NSW; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Dr Peter Heathcote, Senior Urologist, Princess Alexandra Hospital, and Adjunct Professor, Australian Prostate Cancer Research Centre, QLD; Melissa Le Mesurier, Consumer; Dr James Lynam, Medical Oncologist Staff Specialist, Calvary Mater Newcastle and The University of Newcastle, NSW; John McDonald, Consumer; Michael Twycross, Consumer; Rosemary Watson, 13 11 20 Consultant, Cancer Council Victoria.
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