What is Bladder Removal Surgery (Cystectomy)? Purpose, Procedure & Recovery

Bladder removal surgery, called cystectomy, is a procedure where surgeons remove part or all of your bladder. This surgery becomes necessary when your bladder has serious damage from cancer, severe infections, or other conditions that don't respond to other treatments.

While the thought of bladder surgery can feel overwhelming, understanding what happens during this procedure can help ease your concerns. Modern surgical techniques have made cystectomy safer and recovery more manageable than ever before.

What is bladder removal surgery (cystectomy)?

Cystectomy is a surgical procedure that removes either part of your bladder (partial cystectomy) or your entire bladder (radical cystectomy). Think of it as your medical team's way of eliminating diseased tissue that poses a serious threat to your health.

During a partial cystectomy, surgeons remove only the affected portion of your bladder wall. Your remaining bladder tissue continues to function, though it may hold less urine than before. This approach works best when the problem affects just one area of your bladder.

A radical cystectomy involves removing your entire bladder along with nearby lymph nodes. In men, this may include the prostate and seminal vesicles. In women, it might include the uterus, ovaries, and part of the vagina. After complete bladder removal, surgeons create a new way for your body to store and pass urine.

Why is bladder removal surgery done?

Doctors recommend cystectomy when your bladder has serious disease that threatens your health and doesn't respond to less invasive treatments. The most common reason is bladder cancer that has grown into the muscle wall of your bladder or returned after initial treatment.

Your medical team might also suggest this surgery for several other serious conditions that significantly impact your quality of life:

• Muscle-invasive bladder cancer that hasn't spread to other organs
• High-grade bladder cancer that keeps returning despite treatment
• Severe radiation damage to your bladder from previous cancer treatments
• Chronic bladder infections that cause constant pain and don't heal
• Birth defects that severely affect bladder function
• Neurogenic bladder that causes kidney damage

Less commonly, doctors might recommend cystectomy for rare conditions like severe interstitial cystitis that doesn't respond to any other treatment. Your surgeon will only suggest this major surgery when the benefits clearly outweigh the risks for your specific situation.

When other treatments haven't worked

Before considering cystectomy, your medical team will typically try other treatments first. These might include chemotherapy, radiation therapy, immunotherapy, or medications to control bladder function.

Surgery becomes the recommended option when these treatments don't control the disease or when your condition poses immediate risks to your kidneys or overall health. Your doctor will explain why other options aren't suitable for your particular case.

What is the procedure for bladder removal surgery?

Bladder removal surgery typically takes between 4 to 8 hours, depending on whether you need partial or complete removal. Your surgical team will use either traditional open surgery or minimally invasive techniques like laparoscopic or robotic surgery.

During the procedure, you'll be under general anesthesia, so you won't feel any pain or remember the surgery. Your surgeon will make incisions to access your bladder and carefully remove the diseased tissue while protecting nearby organs and structures.

Steps during partial cystectomy

For partial bladder removal, your surgeon follows a careful sequence to preserve as much healthy bladder tissue as possible:

1. Making a small incision in your lower abdomen
2. Identifying and isolating the diseased portion of your bladder
3. Removing the affected tissue along with a margin of healthy tissue
4. Checking nearby lymph nodes for signs of disease
5. Reconstructing your bladder by stitching the remaining tissue together
6. Placing a catheter to help your bladder heal properly

This approach preserves your natural ability to store and pass urine, though your bladder capacity may be somewhat reduced. Most people adapt well to these changes over time.

Steps during radical cystectomy

Complete bladder removal requires more extensive surgery and reconstruction to create a new way for your body to handle urine:

1. Making a larger incision from your breastbone to your pubic area
2. Carefully disconnecting your bladder from surrounding structures
3. Removing your entire bladder and nearby lymph nodes
4. Taking out additional organs if cancer has spread nearby
5. Creating a new urinary diversion using a piece of your intestine
6. Connecting your ureters to the new urinary system

Your surgeon will create one of three types of urinary diversions based on your health, age, and personal preferences. Each option has different benefits and considerations that your medical team will discuss with you beforehand.

Types of urinary reconstruction

After complete bladder removal, surgeons create new ways for your body to collect and eliminate urine. The three main options each work differently and require different levels of self-care.

An ileal conduit uses a small piece of your small intestine to create a pathway from your kidneys to an opening (stoma) on your abdomen. Urine flows continuously into a collection bag that you empty throughout the day. This is often the simplest option for older patients or those with other health conditions.

A continent cutaneous reservoir creates an internal pouch from intestinal tissue with a small opening on your abdomen. You insert a thin tube (catheter) through this opening several times daily to drain urine. This option eliminates the need for an external bag but requires you to perform regular catheterizations.

A neobladder reconstruction creates a new bladder using a portion of your intestine that connects directly to your urethra. This allows you to urinate more naturally through your usual opening, though you may need to use abdominal muscles to empty completely and might experience some leakage initially.

How to prepare for your bladder removal surgery?

Preparing for cystectomy involves several important steps that help ensure the best possible outcome. Your medical team will guide you through each preparation phase, typically starting about two weeks before your surgery date.

Your doctor will first complete comprehensive testing to make sure you're healthy enough for major surgery. This usually includes blood tests, heart function studies, lung function tests, and imaging scans to check for any hidden health issues.

Medical preparations before surgery

Several medical steps help optimize your body for the upcoming procedure and reduce the risk of complications:

• Stopping certain medications that increase bleeding risk
• Managing diabetes or blood pressure with adjusted medications
• Treating any infections with antibiotics
• Receiving blood tests to check your kidney and liver function
• Getting cardiac clearance if you have heart conditions
• Meeting with an anesthesiologist to discuss pain management

Your surgical team will provide specific instructions about which medications to continue and which to stop. Never stop prescribed medications without checking with your doctor first, as some need to be tapered gradually.

Lifestyle preparations

Making certain lifestyle changes before surgery can significantly improve your recovery experience. Your body heals better when it's in the best possible condition before the procedure.

If you smoke, stopping at least two weeks before surgery dramatically reduces your risk of breathing complications and helps your incisions heal faster. Your doctor can prescribe medications or recommend programs to help you quit temporarily or permanently.

Eating a nutritious diet rich in protein helps your body build the resources it needs for healing. Focus on lean meats, fish, eggs, beans, and plenty of fruits and vegetables. Stay well-hydrated unless your doctor gives you specific fluid restrictions.

Gentle exercise like walking can improve your circulation and lung function before surgery. However, avoid strenuous activities that might cause injury. Your physical therapist might teach you breathing exercises to prevent pneumonia after surgery.

Bowel preparation

Since your surgeon may use part of your intestine for reconstruction, you'll need to clean out your bowel system before surgery. This process, called bowel prep, usually starts one to two days before your procedure.

Your medical team will provide specific instructions for a clear liquid diet and laxative medications. While bowel prep can be uncomfortable, following these instructions exactly helps prevent infections and ensures your surgeon has the cleanest possible working environment.

How long does recovery take after cystectomy?

Recovery from bladder removal surgery typically takes several months, with most people returning to normal activities within 6 to 12 weeks. Your healing timeline depends on factors like your overall health, the type of surgery you had, and how well you follow your recovery plan.

The first few days after surgery happen in the hospital, where your medical team monitors your healing and manages your pain. Most people stay in the hospital for 5 to 10 days, depending on the complexity of their surgery and how quickly their body systems start functioning normally again.

What to expect in the hospital

Your immediate recovery focuses on helping your body adjust to the changes and preventing complications. During your hospital stay, several important healing processes take place.

You'll have multiple tubes and catheters that help drain fluids and allow your surgical sites to heal properly. These might include a urinary catheter, drainage tubes near your incision, and possibly a nasogastric tube to rest your digestive system. While these can feel uncomfortable, they're essential for proper healing.

Pain management is a top priority during your hospital stay. Your medical team will use a combination of medications to keep you comfortable while allowing you to move around and participate in your recovery. Most people find their pain decreases significantly each day.

Getting out of bed and walking short distances usually begins the day after surgery. This movement helps prevent blood clots, pneumonia, and other complications. Your nurses and physical therapists will help you gradually increase your activity level.

Recovery at home

Once you're home, your recovery continues with gradually increasing activity and learning to manage your new urinary system. The first few weeks require patience as your body adapts to significant changes.

You'll need help with daily activities for the first week or two at home. Arrange for family members or friends to assist with cooking, cleaning, and transportation to medical appointments. Avoid lifting anything heavier than 10 pounds for at least 6 weeks.

Follow-up appointments with your surgeon happen frequently at first, then spread out as you heal. These visits allow your medical team to monitor your recovery, remove stitches or staples, and address any concerns you might have.

Learning to manage urinary changes

If you had complete bladder removal, learning to manage your new urinary system becomes an important part of recovery. Specialized nurses called ostomy or urology nurses will teach you the skills you need.

For people with an ileal conduit, learning to change and empty your collection bag becomes routine within a few weeks. The supplies are discreet, and most people return to all their normal activities, including swimming and exercise.

Those with continent reservoirs learn to insert catheters and empty their internal pouch several times daily. This skill takes practice but becomes automatic over time. Many people appreciate not having an external collection bag.

People with neobladders learn new urination techniques and pelvic floor exercises to improve control. Complete continence may take several months to achieve, and some people need to wear protective pads initially.

What are the risks and complications of cystectomy?

Like all major surgeries, cystectomy carries both common risks that affect many patients and rare complications that happen infrequently. Understanding these possibilities helps you make informed decisions and recognize symptoms that need immediate medical attention.

Your surgical team takes numerous precautions to minimize these risks, and most people recover without serious complications. However, being aware of potential problems helps you participate actively in your recovery and seek help when needed.

Common short-term risks

Several complications can occur in the days and weeks immediately following surgery, though most are manageable with proper medical care:

• Bleeding that might require blood transfusion
• Infection at the surgical site or in your urinary system
• Blood clots in your legs that could travel to your lungs
• Pneumonia from shallow breathing after anesthesia
• Delayed return of normal bowel function
• Leakage from surgical connections that usually heals with time

Your medical team monitors you closely for these complications and treats them promptly if they occur. Many of these risks decrease significantly as you become more mobile and your body systems return to normal function.

Long-term complications to watch for

Some complications can develop months or years after surgery, requiring ongoing monitoring and occasional additional treatments. Being aware of these possibilities helps you maintain good long-term health.

Kidney problems can develop if your new urinary system doesn't drain properly or if infections travel upward from your urinary diversion. Regular follow-up appointments include tests to monitor your kidney function and catch problems early.

Vitamin B12 deficiency may occur because the surgery removes part of your intestine that normally absorbs this vitamin. Your doctor will monitor your B12 levels and prescribe supplements if needed. This is easily managed with regular injections or high-dose oral supplements.

Sexual function changes affect many people after cystectomy, particularly men who may experience erectile dysfunction. Women might have vaginal dryness or discomfort. Your medical team can discuss treatments and strategies to address these concerns.

Rare but serious complications

While uncommon, some serious complications require immediate medical attention and may need additional surgery to correct:

• Severe bleeding that doesn't stop with conservative treatment
• Complete blockage of your urinary diversion
• Severe infection that spreads throughout your body
• Heart attack or stroke during or after surgery
• Severe allergic reactions to anesthesia or medications
• Injury to nearby organs during surgery

These complications are rare, occurring in less than 5% of patients, but knowing their symptoms helps you seek immediate help if they occur. Your surgical team's experience and modern monitoring techniques have made these serious complications much less common than in the past.

When should I see a doctor after cystectomy?

Knowing when to contact your medical team after bladder removal surgery helps ensure proper healing and prevents minor issues from becoming serious problems. Your doctors want to hear from you if you have any concerns, no matter how small they might seem.

You should call your surgeon immediately if you develop fever higher than 101°F (38.3°C), severe abdominal pain that doesn't improve with prescribed medications, or heavy bleeding from your incision or urinary diversion. These symptoms could indicate infection or other complications that need prompt treatment.

Signs that need immediate medical attention

Certain symptoms require emergency medical care because they might indicate serious complications that could threaten your health:

• Chest pain or difficulty breathing that could signal blood clots
• No urine output for more than 6 hours
• Severe nausea and vomiting that prevents you from keeping fluids down
• Signs of severe dehydration like dizziness or confusion
• Sudden severe pain in your abdomen or back
• Redness, warmth, or pus draining from your incision

Don't hesitate to call 911 or go to the emergency room if you experience these symptoms. Early treatment of complications often prevents more serious problems and helps you get back on track with your recovery.

When to schedule routine follow-up

Regular follow-up appointments are essential for monitoring your long-term health and catching potential problems before they become serious. Your medical team will schedule these visits at specific intervals based on your individual needs.

Typical follow-up schedules include visits at 2 weeks, 6 weeks, 3 months, 6 months, and then annually. These appointments include physical exams, blood tests to check your kidney function, and imaging studies to monitor for cancer recurrence if applicable.

You should also contact your doctor if you notice gradual changes in your urinary output, persistent pain that seems to be getting worse rather than better, or any new symptoms that concern you. Your medical team is there to support you throughout your entire recovery journey.