Dr. Geoffrey Gotto, MD, MPH, FRCSC, Urologic Oncologist

Duration: 4 minutes and 06 seconds

If you've been diagnosed with bladder cancer and your doctor has recommended surgery, you might be facing a procedure called a cystectomy.

A cystectomy is a surgical procedure to remove the bladder. It’s often done when bladder cancer has spread into the muscle layer of the bladder or when non-muscle invasive bladder cancer has returned or become more aggressive.

Most commonly, patients receive a radical cystectomy – where entire bladder is removed, along with nearby lymph nodes and sometimes other organs that might be affected by the cancer. For men, this may include the prostate and seminal vesicles. For women, it may involve removing the uterus, ovaries, and part of the vaginal wall.

Before the surgery, your healthcare team will prepare you: - Pre-operative Tests: Blood tests, imaging scans, and an assessment of your overall health will be done to ensure you're ready for surgery. In some centres, an exercise program or pre-habilitation program may be recommended before surgery. - Discussion with Surgeon: Your surgeon will explain the procedure, the risks involved, and what to expect during recovery. - Anesthesia Consultation: You’ll meet with the anesthesiologist who will explain how you’ll be kept comfortable and pain-free during the surgery.

The surgery itself can be performed in 2 main ways: - Open Surgery: The surgeon makes a large incision in the abdomen to access and remove the bladder.

- Minimally Invasive Surgery (Laparoscopic or Robotic Surgery): The surgeon makes several small incisions and uses a camera and special tools to remove the bladder. This approach may result in a quicker recovery and less pain. The surgery usually takes several hours and is done under general anesthesia, meaning you'll be asleep and won't feel anything during the procedure.

Since the bladder stores urine, after it's removed, the surgeon will create a new way for your body to store and pass urine. There are a few options: - Ileal Conduit: A small piece of the intestine is used to create a passage (conduit) that connects the ureters (tubes that carry urine from the kidneys) to an opening (stoma) on the outside of your abdomen, where urine drains into a bag worn on the skin.

- Continent Urinary Reservoir: A pouch is created inside your body using part of your intestine. You’ll learn to empty the pouch by inserting a catheter (a thin tube) into a small stoma on your abdomen. - Neobladder: A new bladder is constructed from a piece of your intestine and connected to your urethra, allowing you to pass urine through the urethra like before. You may need to learn new techniques to empty your neobladder completely.

Your surgeon will discuss the best option for you based on your health, cancer stage, and personal preferences. The majority of patients will need an ileal conduit.

Expect to stay in the hospital for 5 to 10 days after the surgery, depending on the type of procedure and your overall health. You’ll be given pain medication to manage discomfort. Gradually, you’ll be encouraged to move around to prevent complications like blood clots. You’ll start with a liquid diet and slowly transition to solid foods as your digestive system recovers. Living without a bladder will require some adjustments, especially if you have a stoma or neobladder. If you have an ileal conduit, you’ll learn how to care for your stoma and change the urine collection bag. If you have a neobladder, pelvic floor exercises can help strengthen the muscles needed for controlling urination. Regular check-ups will be needed to monitor your recovery and check for any signs of cancer recurrence.

Undergoing a cystectomy is a major surgery that can be emotionally and physically challenging. It’s important to seek support from healthcare professionals, loved ones, and support groups.

What is important to remember about bladder cancer surgery is that a cystectomy involves removing the bladder to treat bladder cancer and different types of urinary diversions are created to allow urine to exit the body after the bladder is removed. Recovery requires adjustment and ongoing medical follow-up, but many patients go on to live full lives after the procedure.

If you've been diagnosed with bladder cancer and your doctor has recommended surgery, you might be facing a procedure called a cystectomy.

A cystectomy is a surgical procedure to remove the bladder. It’s often done when bladder cancer has spread into the muscle layer of the bladder or when non-muscle invasive bladder cancer has returned or become more aggressive.

Most commonly, patients receive a radical cystectomy – where entire bladder is removed, along with nearby lymph nodes and sometimes other organs that might be affected by the cancer. For men, this may include the prostate and seminal vesicles. For women, it may involve removing the uterus, ovaries, and part of the vaginal wall.

Before the surgery, your healthcare team will prepare you: - Pre-operative Tests: Blood tests, imaging scans, and an assessment of your overall health will be done to ensure you're ready for surgery. In some centres, an exercise program or pre-habilitation program may be recommended before surgery. - Discussion with Surgeon: Your surgeon will explain the procedure, the risks involved, and what to expect during recovery. - Anesthesia Consultation: You’ll meet with the anesthesiologist who will explain how you’ll be kept comfortable and pain-free during the surgery.

The surgery itself can be performed in 2 main ways: - Open Surgery: The surgeon makes a large incision in the abdomen to access and remove the bladder. - Minimally Invasive Surgery (Laparoscopic or Robotic Surgery): The surgeon makes several small incisions and uses a camera and special tools to remove the bladder. This approach may result in a quicker recovery and less pain.

The surgery usually takes several hours and is done under general anesthesia, meaning you'll be asleep and won't feel anything during the procedure.

Since the bladder stores urine, after it's removed, the surgeon will create a new way for your body to store and pass urine. There are a few options: - Ileal Conduit: A small piece of the intestine is used to create a passage (conduit) that connects the ureters (tubes that carry urine from the kidneys) to an opening (stoma) on the outside of your abdomen, where urine drains into a bag worn on the skin. - Continent Urinary Reservoir: A pouch is created inside your body using part of your intestine. You’ll learn to empty the pouch by inserting a catheter (a thin tube) into a small stoma on your abdomen. - Neobladder: A new bladder is constructed from a piece of your intestine and connected to your urethra, allowing you to pass urine through the urethra like before. You may need to learn new techniques to empty your neobladder completely. Your surgeon will discuss the best option for you based on your health, cancer stage, and personal preferences. The majority of patients will need an ileal conduit.

Expect to stay in the hospital for 5 to 10 days after the surgery, depending on the type of procedure and your overall health. You’ll be given pain medication to manage discomfort. Gradually, you’ll be encouraged to move around to prevent complications like blood clots. You’ll start with a liquid diet and slowly transition to solid foods as your digestive system recovers. Living without a bladder will require some adjustments, especially if you have a stoma or neobladder. If you have an ileal conduit, you’ll learn how to care for your stoma and change the urine collection bag. If you have a neobladder, pelvic floor exercises can help strengthen the muscles needed for controlling urination. Regular check-ups will be needed to monitor your recovery and check for any signs of cancer recurrence.

Undergoing a cystectomy is a major surgery that can be emotionally and physically challenging. It’s important to seek support from healthcare professionals, loved ones, and support groups.

What is important to remember about bladder cancer surgery is that a cystectomy involves removing the bladder to treat bladder cancer and different types of urinary diversions are created to allow urine to exit the body after the bladder is removed. Recovery requires adjustment and ongoing medical follow-up, but many patients go on to live full lives after the procedure.

Presenter: Dr. Geoffrey Gotto, Oncologist, Calgary, AB

Local Practitioners: Oncologist