Surgery: cystectomy

Most people with muscle-invasive disease have surgery to remove the bladder (cystectomy). This may also be recommended for high-risk non-muscle-invasive bladder cancer 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:

• How the surgery is done
• Surgery to remove the bladder
• What to expect after surgery
• Sexuality and fertility after cystectomy

How the surgery is done

Surgery to remove the bladder (cystectomy) and create a urinary diversion 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) in the abdomen. A cut is usually made from the area below the bellybutton to the pubic area.
• Keyhole surgery, also known as minimally invasive or laparoscopic surgery, makes several smaller cuts in the abdomen. Instruments are inserted through the cuts, sometimes with help from a robotic system.

Recovery may be faster and the hospital stay may be shorter with keyhole surgery, but the surgery may be more difficult and take longer.

In general, having an experienced surgeon is more important than the type of surgery.

Talk to your surgeon about the pros and cons of each surgical method, and check what you’ll have to pay. Unless you are treated as a public patient in a public hospital, there are likely to substantial costs not covered by Medicare or your health fund.

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 and there are different options, including urostomy, neobladder and continent urinary diversion. See more on urinary diversions.

What to expect after surgery

When you wake up after the operation, you will be in a recovery room near the operating theatre. Once you are fully conscious, you will be transferred to the ward.

	Tubes and drips You may have an intravenous (IV) drip to give you fluid and medicine, and a tube in your abdomen to drain fluid from the operation area. These will be removed as you recover.
	Pain and discomfort After a major operation, it is common to feel some pain. You will be given pain medicine as a tablet (orally), through a drip (intravenously) or through a catheter inserted in the spaces in the spine (epidural). If you still have pain, let your doctor or nurse know so they can change your medicine as needed.
	Recovery time You will probably be in hospital for 1–2 weeks, but it can take 6–8 weeks to fully recovery from a cystectomy. The recovery time will depend on the type of surgery, your fitness and whether you have any complications. Depending on the type of work you do, you will probably need around 4–6 weeks leave from your job.
	Urination A cystectomy will affect how you store urine and urinate. See more on urinary diversions.