Bladder Removal Surgery: What is a Radical Cystectomy?

What is a radical cystectomy?

A radical cystectomy is surgery to remove the bladder to prevent cancer from spreading. It may also involve removing lymph nodes and some, or all, of the urethra. As doctors gauge the level at which the cancer has spread, other organs may also be removed.

A urologist may suggest removal of the bladder if a bladder tumor invades the muscle wall or if CIS or a T1 tumor still persists after BCG therapy. The procedure can be performed on both men and women. In men, organs near the bladder that are often removed include the prostate and the seminal vesicles. In women, a radical cystectomy may also include the removal of the uterus, ovaries, and fallopian tubes. In some cases, parts of the vagina may also be removed.

Before any bladder removal 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.

A radical cystectomy also involves creating a urinary diversion since the bladder is removed during the procedure. This urinary diversion involves using parts of the intestines to allow urine to pass from the kidneys to either an ileal conduit, urinary reservoir pouch called an Indiana Pouch, or a neobladder.

Download our free two page radical cystectomy information sheet here.

Alternatives to a Radical Cystectomy

There are various alternatives to a radical cystectomy. These include:

  • A partial cystectomy, where only part of the bladder is removed
  • Radiotherapy
  • Chemotherapy
  • A combination of radiotherapy and chemotherapy
  • Bladder preservation

Risks and Benefits of a Radical Cystectomy

A radical cystectomy is a complex procedure that involves removing one or more organs from the body. It has its fair share of risks. Oftentimes, however, it’s done because it can offer the best quality of life and the chance of long-term survival for patients who have been diagnosed with bladder cancer. A radical cystectomy is considered major surgery and at least 20% of patients have complications as a result, regardless of approach. Your doctor will discuss the risks and benefits of bladder removal surgery to treat your bladder cancer. 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.

Managing Life After Bladder Removal Surgery

It takes some time to adjust to the changes after bladder removal. It’s not uncommon for patients to have difficulty controlling their bladder following surgery, depending on the urinary diversion that is done. For this reason, incontinence pads or briefs may need to be worn for a period of time. Patients can also expect regular follow-up care and appointments to ensure the urinary diversion drains appropriately.

Doctors typically advise restricting certain strenuous activities until about six weeks post-surgery.  Depending on your profession, these activities include lifting, driving, bathing, and even working.

Beyond the physical impact of surgery, patients may grapple with fears of cancer recurrence, anxiety, depression, body image concerns, and limited mobility. These concerns are entirely valid, and one of the most effective ways to address them is by discussing them openly, possibly with peers who have faced similar experiences. Caregivers play a crucial role during the initial weeks, offering invaluable support to patients.

Webinar: Adjusting to Bladder Removal

Lifestyle, Emotional, and Emotional Aspect of Bladder Removal

Caregiver Considerations After Bladder Removal

 Psychosocial Adjustments after Bladder Removal

Urinary Reconstruction Options After Bladder Removal Surgery

Ileal conduit

An ileal conduit is 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. Learn more about an ileal conduit, how it’s created, and tips for living with one.

An Ileal conduit is when 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.  This is sometimes done after a radical cystectomy, or bladder removal.

Read some practical questions & answers from Nancy, a bladder cancer survivor with an ileal conduit.

What is a continent cutaneous pouch (CCP)?

A continent cutaneous pouch (CCP), also known as an “Indiana pouch” is 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. 

Learn more about the Indiana pouch here, along with advice from patients who have experienced it.

Diagram of Continent cutaneous pouch (CCP).   This is sometimes done after a radical cystectomy, or bladder removal.

What is a neobladder?

A neobladder is 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.  

Learn more about neobladders here, along with advice from patients.

FAQs About Bladder Cancer Surgery

What is the reason for radical cystectomy?

Diagram of what a neobladder looks like.   This is sometimes done after a radical cystectomy, or bladder removal.

A radical cystectomy is performed to extend a patient’s life in the event that they’ve been diagnosed with bladder cancer. A radical cystectomy may not just remove the bladder, but also may remove any surrounding lymph nodes or organs in which cancer has spread.

Are there alternatives to a radical cystectomy?

Yes, bladder preservation therapy using chemotherapy, radiotherapy, or a combination of all of these are common alternatives may be available. Speak with your doctor to see if this is the best treatment for you.

What risks are associated with a radical cystectomy?

A radical cystectomy is a major surgery, and there are certain risks that accompany it. A few of the biggest risks include bleeding, kidney issues, infection (and issues that may stem from infection), and complications from the urinary diversion.

Where can I get more information about a radical cystectomy?

In Adapting to the “New Normal,” Darrell and Steven discuss how they maintained their quality of life after their bladder cancer diagnoses and subsequent surgical interventions. BCAN’s “The New Normal: Living with a Urinary Diversion” video series profiles eight bladder cancer survivors discussing their urinary diversion choice and sharing their experiences to let others know about living well with a urinary diversion.

What can I eat after radical cystectomy surgery?

Maintaining a balanced diet is essential, ensuring you get sufficient protein and calories to support your weight while avoiding spicy, greasy, and high-fiber foods to minimize bloating. During meals, consider limiting your liquid intake to prevent that ‘overly full’ sensation. However, during your recovery phase, it’s crucial to stay well-hydrated to prevent complications like urinary tract infections. To achieve this, drink plenty of water throughout the day and skip sugary beverages that may not be suitable for your recovery. Additionally, sipping on warm beverages can help prevent diarrhea, gas, and discomfort while minimizing odors.

Radical cystectomy webinar

Watch our webinar about bladder removal surgery, presented by Dr. Alexander Kutikov from Fox Chase Cancer to learn more.

Information and services provided by the Bladder Cancer Advocacy Network (BCAN) are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, seek professional medical attention immediately! BCAN does not recommend or endorse any specific physicians, treatments, procedures or products even though they may be mentioned on this site.