What is a cystectomy?

There are two types of cystectomy procedures, simple and radical. In a simple cystectomy the doctor removes your bladder. In a radical cystectomy the doctor removes the surrounding lymph nodes and glands in addition to your bladder. Ask your doctor which of these procedures he or she will do.

When is it used?

• You may have cancer in the bladder (usually a radical cystectomy will be performed).

• The bladder's nerve-muscle control may not be working well, which would mean you cannot empty or control the flow of urine (usually a simple cystectomy will be performed).

• The bladder may be damaged from radiation treatment.

• The bladder may be damaged or may bleed from other treatments or causes.

• The bladder may be bleeding from chemotherapy.

Examples of alternatives are:

• having radiation therapy, chemotherapy, photodynamic therapy, or other forms of cancer treatment if you have cancer

• choosing not to have treatment while recognizing the risks of your condition.

You should ask your doctor about these choices.

How do I prepare for a cystectomy?

Make sure that you talk to your doctor about the procedure, its effects on you, and the likely outcome. Plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties.

For 1 week before your surgery, do not take aspirin, ibuprofen (such as Motrin or Advil), or any other nonprescription pain relievers except for acetaminophen (such as Tylenol). You may take acetaminophen for pain.

Follow instructions provided by your doctor. Your doctor will give you laxatives and antibiotic pills to cleanse your bowels. Do not eat anything the night before the procedure, and drink only clear liquids. After midnight and the morning before the procedure, do not eat or drink anything. Do not even drink coffee, tea, or water.

What happens during the procedure?

You are given a general anesthetic. A general anesthetic relaxes your muscles and makes you feel as if you are in a deep sleep. It prevents you from feeling pain during the operation.

The doctor will make a cut in your abdomen to expose the bladder and tie off the blood supply to it. Then he or she will remove the bladder (a simple cystectomy). If necessary, the doctor will also remove the lymph nodes in the area (a radical cystectomy).

Another passage will be made for urine. The doctor will remove part of the small intestine and attach the ureters to one end of it. The ureters are the two tubes connecting the kidneys to the bladder and through which urine passes into the bladder. The doctor will sew the other end of the piece of intestine to the skin. Finally, the doctor will close the cut.

An external bag is attached to the opening to collect the urine. In some cases, the doctor may be able to construct a bladder out of a piece of the intestine.

What happens after the procedure?

You may be in the hospital at least 2 to 12 days. You may spend the first few days in an intensive care unit. You may have a tube that passes through your nose into your stomach for a few days after surgery. A bag on your side will collect urine as it flows out of the new passage. The bag may be permanent or temporary. You will need to learn how to dispose of your urine.

You should avoid strenuous activity for the next 4 to 6 weeks.

Ask your doctor what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

• You will no longer have to deal with a diseased or poorly functioning bladder.

• If there was cancer in the bladder, the disease may be removed.

What are the risks associated with this procedure?

Though many women do well throughout the procedure and live comfortably thereafter, there are risks:

• There are some risks when you have general anesthesia. Discuss these risks with your doctor.

• The nerves and blood vessels around the bladder could be cut or damaged.

• Fluid from the lymph nodes may leak where they were removed and may collect in the abdominal cavity.

• Your rectum could be cut and may need surgical repair.

• Your intestine could leak where the section of it was removed, or it could become narrowed and require surgery.

• Urine could leak out where the ureters are joined to the section of intestine.

• The ureters could become blocked and prevent urine from passing.

• The cut in your abdomen may not heal well and may become infected.

• The skin around the area where the intestine is sewed to the skin could become infected.

• The operation may not remove all of the cancer if that was the reason for surgery.

• Your sexual function may be affected by the surgery.

• You may require further treatment.

• Infection and bleeding may occur.

You should ask your doctor how these risks apply to you.

When should I call the doctor?

Call the doctor immediately if:

• You have trouble passing urine.

• You develop a fever.

• You have nausea or vomiting.

Call the doctor during office hours if:

• You have questions about the procedure or its result.

• You want to make another appointment.