Bladder Removal (Cystectomy) for Men

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KEY POINTS

• Cystectomy is surgery to remove the bladder.
• Your bladder may need to be removed to treat cancer in the bladder, severe chronic infection, bleeding, or other damage.
• Ask your provider how long it will take to recover and how to take care of yourself at home.
• Make sure you know what symptoms or problems you should watch for and what to do if you have them.

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What is a cystectomy?

Cystectomy is surgery to remove the bladder.

• A partial cystectomy removes part of your bladder, leaving enough of it so that you can still urinate normally.
• If just the bladder is removed, the procedure is called a simple cystectomy.
• If the bladder, nearby lymph nodes, and nearby organs and tissues are removed, it’s called a radical cystectomy. Lymph nodes are the size of a pea and are found throughout your body. The lymph system consists of lymph nodes that store blood cells (lymphocytes) to fight infection and vessels that carry fluid, nutrients, and wastes between your body and your bloodstream. Many types of cancer spread through the lymph system. Removing nearby lymph nodes can limit how far the cancer can spread.

When the bladder is removed, your provider will create a new way for urine to leave your body.

When is it used?

Your bladder may be removed to treat problems such as:

• Bladder cancer
• Bladder damage from radiation treatment, chemotherapy, or a severe infection
• Bleeding from the bladder that cannot be controlled
• Nerve or muscle damage from a nerve disease or spinal cord injury that keeps your bladder from working properly

Partial cystectomy may be done to treat bladder cancer if the tumor in your bladder is not too large and can be removed without hurting how your bladder works. A partial cystectomy is rarely done because in most cases bladder cancer involves several areas in the bladder. The risk of cancer coming back is much higher when just part of your bladder is removed.

Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It’s best to quit 6 to 8 weeks before surgery.
• You may or may not need to take your regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements that you take. Some products may increase your risk of side effects. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• Tell your healthcare provider if you have any food, medicine, or other allergies such as latex.
• Your healthcare provider may prescribe antibiotics for you to take a few days before and after surgery to help prevent infection.
• Your healthcare provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Your healthcare provider may ask you to take an enema or medicine to clean out your bowel before surgery.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for any tests or procedures.

What happens during the procedure?

This procedure is done at the hospital.

You will be given a general anesthetic before the procedure to keep you from feeling pain. General anesthesia relaxes your muscles and you will be asleep. Your healthcare provider will make a cut in the lower part of your belly. Your provider will remove part of or all of the bladder. For a radical cystectomy, the prostate gland may also be removed.

If all of your bladder is removed, your healthcare provider may:

• Create a new way for urine to pass out of your body through an opening in your belly (a urostomy). Your provider will create a pouch to collect urine inside your body, or a bag will be attached to the opening outside your belly.
• Make a new bladder (neo-bladder) from a piece of your small intestine and put it in the same position as your original bladder inside your body. The neo-bladder is connected to the urethra (the tube that normally drains urine from your body) so that a urostomy will not be needed.

What happens after the procedure?

You may be in the hospital for several days, depending on your condition.

If you have a partial cystectomy or a neo-bladder, you may have a catheter, which is a small tube used to drain urine from your bladder. Your healthcare provider will tell you how to take care of the catheter when you go home and when it can be removed. A catheter is left to drain the neo-bladder until it heals. This usually takes about 3 weeks. After removal of the catheter, your bladder may not hold as much urine as it used to, so you may need to urinate more often. Over time, the bladder usually stretches and can hold more urine.

If your bladder is removed, you may be in an intensive care unit for the first 2 or 3 days. You will need to learn how to drain or dispose of your urine.

If the prostate gland and seminal vesicles are removed, you will be sterile and unable to make a woman pregnant. You may also have some problems with your erection. Ask your healthcare provider about things that might help.

Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• You may have problems with anesthesia.
• You may have infection, bleeding, or blood clots.
• Other parts of your body may be injured during the surgery.
• You may lose feeling in the groin area if lymph nodes are also removed.
• Your bowel function may change. You may have frequent bowel movements or diarrhea.

Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.