Surgery Overview

Cystectomy is the surgical removal of all or part of the bladder. It is used to treat bladder cancer that has spread into the bladder wall or to treat cancer that has come back (recurred) following initial treatment. There are three types of cystectomy:

• Partial cystectomy is the removal of part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area. Partial cystectomy is only a good choice if the cancer is not near the openings where urine enters or leaves the bladder.
• Simple cystectomy is the removal of all of the bladder.
• Radical cystectomy is the removal of the entire bladder, nearby lymph nodes (lymphadenectomy), part of the urethra, and nearby organs that may contain cancer cells.
  • In men, the prostate, the seminal vesicles, and part of the vas deferens are also removed.
  • In women, the cervix, the uterus, the ovaries, the fallopian tubes, and part of the vagina are also removed.

The surgery is done through a cut (incision) the doctor makes in your lower belly. Sometimes it can be done as laparoscopic surgery. Some people call this "Band-Aid surgery," because it requires only small cuts. To do this type of surgery, a doctor puts a lighted tube, or scope, and other surgical tools through small cuts in your lower belly. The doctor is able to see your organs with the scope.

If you have a simple cystectomy or radical cystectomy, your doctor will create a new way to pass urine from your body. There are several ways this can be done.

• An ileal conduit uses a piece of your small intestine to make a tube. The tube connects your ureters to an opening the doctor makes in your belly. Your ureters are the two tubes that normally carry urine from the kidneys to the bladder. After surgery, the urine passes from the ureters through the conduit and out the opening into a plastic bag that is attached to your skin.
• A continent reservoir uses a piece of your bowel to create a storage pouch that is attached inside your pelvis. There are two types. Both types let you control when you urinate. You may have a:
  • Bladder substitution reservoir (neobladder). If your urethra was not removed as part of the surgery, your continent reservoir will attach to your ureters at one end and your urethra at the other. This allows you to pass urine much as you did before surgery.
  • Continent diversion reservoir with stoma (urostomy). If all or part of your urethra was removed during your surgery, your continent reservoir will connect your ureters to an opening the doctor makes in your belly. You will pass a thin plastic tube called a catheter through the opening to release the urine.