Treatment which removes your bladder is called a radical cystectomy. It is a major operation and involves creating a new way to wee after the operation either via a stoma or neobladder. You will need to decide which option to have. This page describes the procedures and what's involved, to help you make the decision which is right for you.
This type of treatment is usually offered only to people diagnosed with muscle-invasive bladder cancer or those who have had treatments for high-risk non-muscle invasive bladder cancer which have not been successful. If you or a loved one are in this situation, your treatment team may have told you that surgery to remove your bladder is their advised next step.
You may have also been told that radiotherapy or chemotherapy is an alternative option at this stage – see our page on whole-body treatments. Usually your multi-disciplinary team (MDT) will explain the options open to you so you can make an informed choice. It can be a lot to take in, especially as surgery means adapting to a new way of going to the toilet. So please, take your time to read this information and don‘t hesitate to contact our helpline team or visit our forum if you have questions.
You are not alone. We are here to support you however we can.
A radical cystectomy, or RC, is surgery to remove your bladder as a treatment for muscle-invasive bladder cancer. It also involves removing the nearby lymph nodes, part of the urethra, the prostate (in men) and the cervix and womb (in women). It is a major operation, lasting at least six hours.
The team will assess your health and fitness and you will be encouraged to consider your diet, exercise, sleeping and mood to help prepare you for a life-changing operation. This will optimise the chances of a successful outcome. You will always be advised to stop smoking. You will then be asked to sign a form consenting to the operation.
Recently, some RCs have been carried out using robotic surgery. Currently there is limited evidence about whether this is better than the traditional surgery method as far as long term prognosis is concerned, however, it may result in reduced blood loss and reduced pain after surgery.? It has been demonstrated that this surgery is very important for some patients for whom traditional surgery would be dangerous due to other health issues.
Why should you have a cystectomy?
The benefits of this operation will be discussed with you in more detail, but your doctor may be recommending this surgery for you for the following reasons:
- you have cancer in your bladder that would be best managed by completely removing the bladder
- your bladder may have developed a tumour after radiation treatment
- your bladder may be bleeding after radiotherapy
- your bladder may be damaged or bleeding uncontrollably from other causes or treatments.
For more information on radical cystectomy including how to prepare for surgery and recovery afterwards, download or order a copy of our Muscle-invasive bladder cancer booklet (see link at the bottom of this page).
A stoma or a neobladder?
Anyone having their bladder removed as a treatment for bladder cancer will need another way to wee after the operation. The two main choices in the UK are a stoma which is a hole in the abdomen, or a neobladder, a replacement bladder created out of tissue from the bowel.
Your consultant will explain the options to you and your individual choices. Not everyone is suitable for both procedures. Every person is different – physically and mentally – so what might be right for one person may not be right for another.
A stoma is simply the creation of a hole in the body that allows you to connect part of the inside of your body with the outside. It is used in many operations, but in the case of bladder cancer treatment, it is used to allow you a different way for wee to leave your body when your bladder has been removed.
In simple terms, the operation involves cutting out a small section of your bowel and connecting one end to your ureters (the tubes that drain your wee from your kidneys down to your bladder). The other end of the piece of bowel is poked through a hole in your abdomen so that your wee can flow out. Your medical team might also call it an ileal conduit.
The stoma is usually put just to the right of your tummy button. It can sometimes be repositioned slightly if you have scar tissue, a hernia or other contra-indications, but it is always located within the area of an abdominal muscle called the rectus.
Getting used to having a stoma and learning to live with it will take a bit of time but, like anything new, it will get easier with practice. Most patients find it doesn’t hold them back from doing all the things they normally enjoy.
You will then wear a stoma bag, which is stuck to your skin, to collect the wee as it flows out. When the bag is full, you pull out a little stopper at the end of the bag and empty it straight into the toilet.
It may seem an odd concept at first to have a hole in your abdomen but, in fact, the creation of stomas goes way back in history. It is a tried-and-tested operation.
For more information about living with stoma, including how to prepare for the operation, how to empty and change the bag and day-to-day routines, please download or order a copy of our Stoma booklet (see link at the bottom of this page.
Forming a neobladder is carried out at the same time as you have your bladder removed (a radical cystectomy or RC). To create a neobladder, a piece of your bowel is cut out, and the remaining bowel sewn back together again. The section of bowel that has been removed is opened lengthways and then stitched together to make a new ‘bladder’. This is then joined to your ureters (the pipes that bring your wee from your kidneys to your bladder). This new bladder, the neobladder, is then connected to your urethra, so that your wee is expelled through the normal route.
The procedure is not available in all hospitals.
Another option, which is not common in the UK, is a Mitrofanoff. Surgeons create an artificial reservoir inside the body, in which the urine is stored, with a stoma in the abdominal wall into which the patient can insert a catheter to drain the reservoir when necessary.
It is important that you have good bladder control and do not suffer from incontinence before having neobladder surgery as control will not be improved by surgery.
If your cancer has spread to the urethra, then you will not be able to have a neobladder as the urethra will have to be taken out to ensure all the cancer is removed. Some hospitals do not offer neobladders to patients over 70 as their pelvic floors are not as strong as younger patients.
Before a final decision is made, there will need to be blood tests and scans to make sure that a neobladder is the best option.
Your consultant should provide you with all the information you need to know about the specific details of your operation.
If you are not clear on something, do ask. Make sure you know about all the permanent changes to your body as well as the temporary ones.
Talk to your consultant about sex and make sure you know where to go to find information and any specialist advice and aftercare you need. Ask how many neobladder procedures they do each year and who will deal with any problems if they occur after the op.
A bladder reconstruction is a major operation and it is likely that you will need to stay in hospital for two to three weeks, during which your urology team will watch you closely to monitor your improvement and make sure that no complications occur. You will be given lots of fluids through a drip until you are able to drink enough normally, and you will also be given appropriate pain relief.
The medical team will help to guide you through this process. Don’t be embarrassed to ask questions and keep asking until you have the information and help you need.
For more information on neobladders including risks, looking after yourself and tips from patients about the procedure, please download or order a copy of our Neobladder booklet (see link at the bottom of this page).
Talk to your doctors and CNS so you can balance the risk factors with the potential benefits and make the best choice for you and your lifestyle.
It is important that you understand what is going to happen during the bladder removal operation, so please ask questions if you are at all uncertain.
Making your choice
The operation to construct the stoma is usually performed at the same time as the bladder removal (radical cystectomy (RC)).
Your medical team, including your doctor and clinical nurse specialist (CNS), will explain to you what procedures are involved, what outcome you can expect, and how the stoma operation compares with the operation to create a neobladder.
You can also join the Fight Bladder Cancer private online forum, where patients and professionals can help to answer your queries.
Things to think about when making your choice:
- 80% of patients choose a stoma
- The procedure is suitable for almost all patients
- You'll need to learn how to use, clean and empty the bag
- It involves a shorter operation and recovery time
- It has the potential to affect your body image
- There are potential leakage issues
- Suitable for patients with full kidney and liver function, good bladder control and a healthy urethra
- You'll need to learn techniques to recognise when you need a wee
- It involves a longer operation and recovery time
- You may need to self-catheterise
- There's no need for collection pouch
- There is a potential for incontinence, especially at night, for some time.
Support for you
Please remember that you can contact us at any time for support, whether you are a patient or care for someone who is.
Our helpline is open from 0900-1630, Monday to Friday. There's an answerphone if we're busy, but we will call you back as soon as we can. Call 01844 351 621 or email firstname.lastname@example.org
Talking to other people who have had the same tests, investigations and diagnosis can help. Our private online forum on Facebook is available 24/7, 365 days a year. (See our getting support page for details of how to join and other support available.)
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We’ve tried to make the information on this site as accurate as possible. Whilst we have support from medical professionals to review the general medical content of this site, please remember that only your medical team can give you specific advice about your symptoms or illness. Fight Bladder Cancer is a registered Charitable Incorporated Organisation in Scotland (SC051881), England and Wales (1198773), and was initially established as an unincorporated charity in England and Wales (1157763). It also operates in Northern Ireland.