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Cystectomy

Definition

A cystectomy is a surgery to remove all or part of the bladder:

  • A radical cystectomy removes all of the bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells.
  • A partial cystectomy removes part of the bladder.

Reasons for Procedure

Reasons for a cystectomy include:

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Bleeding
  • Loss of sexual function
  • Fluid build-up in the abdominal cavity
  • Damage to other organs
  • Blockage of urine flow from the ureters to the bladder
  • Nutrition problems, depending on the bowel segments used to create a way for urine to drain
  • Blood clots
  • Reaction to anesthesia
  • Urinary incontinence

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

Previous surgery in the abdomen or pelvis or radiation to the area increases your risk of complications.

What to Expect

Prior to Procedure

You may need to take antibiotics to prevent infection and laxatives to clean out the bowels.

The night before, you may be asked not to eat anything and to only drink clear liquids. Do not eat or drink anything after midnight or on the morning of the procedure. This includes avoiding clear liquids, coffee, tea, and water.

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, such as:

  • Anti-inflammatory drugs
  • Blood thinners
  • Antiplatelets

Anesthesia

General anesthesia is given before surgery. You will be asleep.

Description of Procedure

An incision will be made in the abdomen to expose the bladder. In a radical cystectomy, all blood vessels to the bladder will be cut. The bladder will then be removed along with nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells. In men, the prostate and glands that help produce semen will also be removed. In women, the uterus, ovaries, and, sometimes, part of the vagina will be removed.

The doctor will also need to create a new way for urine to be passed out of the body. A new bladder may be built using pieces of intestine. Or, an external bag may be attached to the abdomen.

In a partial cystectomy, only part of the bladder will be removed.

Kidneys, Ureters, and Bladder
The Urinary System
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How Long Will It Take?

About 3–6 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 5-12 days. The specific length of time will depend on your condition and the reason for surgery. Your doctor may also choose to keep you longer if complications occur.

Post-procedure Care

At the Hospital
  • A stay in the intensive care unit may be needed.
  • During surgery, a tube will be placed from the nose to the stomach. It will stay there for several days. Because you cannot eat with the tube in place, you will receive IV fluids.
  • If a urine bag was attached during the surgery, you will be taught how to dispose of urine.
Preventing Infection

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home

When you return home, do the following to help ensure a smooth recovery:

When you return home, do the following to help ensure a smooth recovery:

  • Difficult physical activity should be avoided for 4-6 weeks.
  • Avoid heavy lifting, straining, and sexual activity until your doctor tells you it is okay.
  • Driving and climbing stairs is usually allowed. Ask your doctor about any restrictions.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

Call your doctor if any of the following occur:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, heavy bleeding, or discharge from the incision and/or stoma site
  • Persistent nausea and/or vomiting
  • Pain that you cannot control with the medicines you have been given
  • Inability to urinate or difficulty urinating, extreme cloudiness or pus in the urine, a bad odor to the urine
  • Cough, shortness of breath, or chest pain

If you think you have an emergency, call for medical help right away.

Revision Information

  • National Kidney and Urologic Diseases Information Clearinghouse

    http://kidney.niddk.nih.gov

  • Urology Care Foundation

    http://www.urologyhealth.org

  • Canadian Urological Association

    http://www.cua.org

  • Public Health Agency of Canada

    http://www.phac-aspc.gc.ca

  • Bladder cancer facts. AP John Institute for Cancer Research website. Available at: http://www.apjohncancerinstitute.org/cancer/bladder.htm. Accessed July 17, 2013.

  • Cystectomy information binder. Johns Hopkins Medicine website. Available at: http://urology.jhu.edu/bladder/Cystectomy.pdf. Accessed July 17, 2013.

  • Maffezzini M, Campodonico F, et al. Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. Surg Oncol. 2008;17(1):41-48.