Bladder Removal Surgery: What is a Cystectomy?

January 11, 2023

What is a radical cystectomy?

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

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.

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

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 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

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. These activities include lifting, driving, bathing, and even working, depending on your profession.

Where can I read more about bladder removal surgery?

Click here to read our Get the Facts | Radical Cystectomy (PDF), filled with advice from patients who have experienced it.

What are the types of urinary reconstructions available if I need to have my bladder removed?

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.

Where can I read more about an ileal conduit?

Our What is an Ileal Conduit page contains information about what is is, how an ileal conduit is created and tips for living with one.

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

What is a 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. 

Where can I read more about an Indiana pouch?

Read our Get the Facts | Indiana Pouch (PDF) publication, filled with advice from patients who have experienced it.

What is a neobladder?

A neobladder is 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.  

Where can I learn more about neobladders?

Our Get the Facts | Neobladder (PDF) publication is filled with advice from patients who have experienced it.

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Common FAQs About Bladder Cancer Surgery

Why is a radical cystectomy performed?

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 experience to let others know about living well with a urinary diversion.

Webinar about a radical cystectomy

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Videos about urinary diversions

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 experience to let others know about living well with a urinary diversion.

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.