Surgery for muscle invasive bladder cancer

Surgery in progress

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Removing the bladder

The aim of surgery for muscle invasive bladder cancer is to remove the cancer and the area close to it.  Surgery to remove the whole bladder and some nearby tissues and organs including the lymph nodes is called a radical or total cystectomy (‘sigh-tec-tommy’). It is the most common type of surgery for muscle invasive bladder cancer.

If your surgeon removes just part of your bladder, it is called a partial cystectomy.

Surgery to help you live without a bladder

If your bladder is removed, you won’t be able to pee in the usual way. So your surgeon will do extra surgery so that you can get rid of urine. There are different ways to do this:

  • Urostomy (‘your-oss-tommy’)
  • Continent urinary diversion
  • Bladder reconstruction (neobladder)

Urostomy

Your surgeon uses a piece of your small bowel to make a tube that comes through the surface of your tummy. 

Clearing your bowels: You may be asked to follow a special diet for a few days before the surgery or to drink a laxative. This is so that your surgeon can get a clean segment of bowel to make the urostomy. 

The two kidney tubes (ureters) are attached to the tube so that urine can flow through them, into the tube and out of your body. The opening is called a stoma and looks like the skin inside your cheek. 

Stoma nurse: The stoma nurse will visit you before surgery to discuss having a stoma. She or he will mark on your skin the best place for the new stoma to be located. She will show you how to take care of it afterwards. 

Stents

For the first 7 to 10 days after your urostomy you will have fine plastic tubes called ureteric stents in you ureters. These keep the ureters open and working while you’re healing. 

They will usually be removed when you return for your follow-up appointment.
 

Getting urostomy supplies: When you leave hospital, you will be given some dressings and urostomy bags to last a few days. You will also be given a prescription for more supplies from your pharmacy. Go to the pharmacy to get these as soon as possible. Most pharmacies do not keep them in stock and it may take a few days for supplies to arrive.

Continent urinary diversion 

Your surgeon uses a piece of your bowel to make an internal pouch that can store urine inside your tummy. The two kidney tubes (ureters) will be then be attached to it. Urine will drain through the ureters into this pouch.

The internal pouch is connected to your tummy wall by a stoma. You empty urine from the pouch through the stoma using a thin tube called catheter. You will need to do it about 5 or 6 times a day. A stoma nurse will teach you how to do it. You do not need a urinary pad or bag. The stoma is covered with a bandage.

Continent urinary diversion diagram

Bladder reconstruction

In this type of surgery, instead of making a stoma the surgeon connects the new pouch to your urethra. The pouch is able to store urine like your bladder did and you pass urine outthrough your urethra. This is known as a neobladder.

To empty the pouch you will need to use your abdominal (tummy) muscles. This can be done by holding your breath and pushing down into the tummy. If you are having a neobladder, your hospital team will be able to give you more detailed information about it.

Bladder reconstruction diagram

Will I get side-effects from surgery?

Surgery to the bladder can affect your bowel and may also affect your sex life. You may also have a urostomy bag, which can take a while to get used to. Read more about the side-effects of muscle-invasive bladder cancer surgery.  

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