Non-Muscle Invasive Bladder Cancer (includes Ta, T1, CIS tumors) , Muscle Invasive Bladder Cancer (includes T2 tumors) , Locally Advanced (includes T3 tumors) , Metastatic Bladder Cancer (includes T4 tumors)

Surgery

Radical cystectomy

Suitable for most people who are healthy enough to undergo surgery to treat muscle-invasive bladder cancer when:

1. There is more than one tumor in the bladder
2. The tumor is high grade, meaning it is likely to spread

• The bladder, surrounding lymph nodes, and nearby tissues and/or organs are removed to take out any tumors. In men, the prostate is often removed, and in women, the surgeon may also remove the uterus, fallopian tubes, ovaries, cervix, and sometimes part of the vaginal wall, depending on the location of the tumor
• This is done under general anesthetic, and you will need to stay in hospital for ~5–14 days. The average recovery time for this procedure is ~6–8 weeks, however time spent in hospital and recovery time can vary from person to person
• After the bladder is removed, the surgeon will create a way for urine to leave the body. There are three different types:

1. 1. Ileal conduit: The surgeon creates a new tube from a piece of intestine that lets urine to pass through and out of the body via a small surgical opening on the stomach, known as a stoma. The urine drains into a small pouch that fits over the stoma and attaches to the skin with an adhesive
   2. Neobladder: The surgeon creates a ‘new bladder’ internal pouch from a piece of intestine, that is attached to the urethra so that urine can pass out of the body
   3. Continent cutaneous pouch or Indiana pouch: The surgeon uses a segment of small and large intestines to create an internal pouch to store urine. This is connected to the skin by a small surgical opening, known as a stoma. Urine is stored in this pouch and is drained via a thin tube called a catheter

• May be recommended if a non-muscle invasive high-grade (aggressive) tumor is still there after treatment with BCG and/or another therapeutic, or if the tumor is muscle-invasive
• Bladder cancer can reoccur after the bladder has been removed, so ongoing monitoring will be needed after surgery. If cancer cells are found elsewhere in the body, another treatment will be given depending on the location and stage of the cancer

N/A

• Pain or discomfort after surgery
• Urine leaks
• Blockage of urine flow
• Infection
• Changes in sexual functioning