Cystectomy for Bladder Cancer: What to Ask Before Surgery

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If you have invasive bladder cancer, your doctor may recommend a cystectomy — surgery that removes part or all of your bladder. Understanding what this procedure entails will help you prepare for the ways it could affect your everyday life. Here’s what you should know.


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Who needs a cystectomy?

If your bladder cancer has grown into the layers of your bladder wall it’s considered invasive and your treatment team may determine you need a cystectomy. If your cancer only exists in your bladder’s inner lining and has not spread to the deeper layers of your bladder, it is considered non-invasive and you likely do not need this procedure.


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What are the types of cystectomies?

There are two types of cystectomies: partial and radical, depending how much of the bladder is removed. Your doctor will recommend the type of cystectomy that is best suited for you based on several factors, such as whether your bladder cancer is invasive or recurrent, as well as your overall health condition.


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How is a cystectomy performed?

Cystectomies should be done by surgeons who have experience treating bladder cancer to ensure the procedure is done well and cancer does not return. During the procedure, the surgeon creates one or more small incisions in your abdomen and inserts a long and thin instrument — a laparoscope — with a video camera at the end to access your bladder and perform the cystectomy. After surgery, you may need to stay in the hospital for about a week to recover.


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What is a partial cystectomy?

If your bladder cancer has spread to the muscle layer of your bladder wall but is only in a small area, a partial cystectomy can remove the cancer along with only a portion of your bladder. After the cystectomy, the surgeon will close the hole in your bladder wall and then remove nearby lymph nodes. Partial cystectomy is beneficial because it allows you to continue to use your bladder and avoid reconstructive surgery.


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What are the benefits and drawbacks?

After a partial cystectomy, your bladder may not hold as much urine as it once did, which means that you may need to urinate more frequently. Another concern following partial cystectomy is that it is possible for your bladder cancer to return to another part of your bladder wall.


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What is a radical cystectomy?

If your bladder cancer has spread to a larger area on the muscle layer of your bladder wall or to more than one area on your bladder, you may need a radical cystectomy to remove your entire bladder and nearby lymph nodes. Men who have a radical cystectomy also have their prostate and seminal vesicles removed while women also have their fallopian tubes, uterus, cervix, and a part of their vagina removed.


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How radical cystectomy affects urination

You will need reconstructive surgery so your body has a way to store and release urine. One surgical option is incontinent diversion: removing a small piece of your intestine and connecting it to the ureters to create a new passage way. During continent diversion, a surgeon will create a pouch from your intestine and attach it to ureters. The other end of the pouch connects to an opening in the skin to allow you to empty it with a drainage tube.


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How a new procedure might ease incontinence

A newer reconstructive surgery following radical cystectomy is a procedure called neobladder. A surgeon can create a new bladder from pieces of your intestines. Your ureters are connected to the new bladder and route your urine back into your urethra. Because the new bladder is sewn to the urethra, you will be able to urinate normally during the day. However, you may still experience some incontinence while sleeping.


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How a radical cystectomy can affect sex for men

Because men who have a radical cystectomy have their prostate gland and seminal vesicles removed as well, they may no longer be able to make semen but still be able to orgasm. Some men may also experience nerve damage that can affect erections, though this side effect can improve over time. It is important to talk to your doctor before surgery about techniques that can decrease this potential outcome.


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How a radical cystectomy can affect sex for women

Women who have radical cystectomy often have the front part of their vaginas removed as well, which can make sex uncomfortable. However, there are several options for performing vaginal reconstruction surgery that can rebuild the vagina. Women should take care to ask how their nerves can be preserved and the blood supply retained to the clitoris during the procedure to avoid future challenges reaching orgasm.