What is a cystectomy?

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

When is it used?

The reasons for removing your bladder include:

• You may have cancer in the bladder (usually requiring a radical cystectomy).

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

• The bladder may be damaged from radiation treatment.

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

• The bladder may be bleeding from chemotherapy.

Examples of alternatives are:

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

• choosing not to have treatment.

You should ask your doctor about these choices.

How do I prepare for a cystectomy?

Plan for your care and recovery after the operation. Allow for time to rest and try to find other 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 will be given general anesthesia before the procedure. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. It will prevent 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 may also remove the nearby lymph nodes, a gland at the bottom of the bladder called the prostate, and two glands called the seminal vesicles (a radical cystectomy).

The doctor will make a new passage for urine. He or she 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 for 2 to 12 days, depending on your condition. You may be in an intensive care unit for the first 2 or 3 days.

• You may have a tube that passes through your nose into the stomach.

• The cut may drain for a few days.

• You will have a bag on your side to collect urine as it flows out of the new passage.

• You will need to learn how to dispose of your urine.

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

• If the prostate gland and seminal vesicles were removed, you will be unable to impregnate a woman.

You should 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?

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

• The nerves and blood vessels around your bladder could be cut or damaged, causing impotence.

• You may lose feeling in the groin area.

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

• Your rectum could be cut, and may require surgical repair.

• The intestine could leak where the section 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 flowing out.

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

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

• You may be impotent.

• If you had cancer, the operation may not remove all of it. The cancer may grow back.

• You may want further treatment.

• 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.