Surgery for invasive and advanced bladder cancer
The most common surgery for invasive bladder cancer is an operation to remove your bladder (cystectomy). You may be given chemotherapy to shrink the cancer before your surgery.
Your doctor will explain which type of operation is the most appropriate for you.
Cystectomy can be carried out for stages 2 and 3 bladder cancer. Cystectomy is also sometimes done for people with early non-invasive bladder cancer that keeps coming back after treatment. If bladder cancer comes back in the bladder after treatment with radiotherapy, it may sometimes be possible to have an operation to remove the bladder. This is called a salvage cystectomy.
Occasionally bladder cancer can be treated with an operation to remove part of the bladder (partial cystectomy). After this operation people are able to pass urine in the usual way. However, because their bladder is smaller and holds less urine, they need to pass urine more often.
Your doctor will explain which type of operation is the most appropriate for you.
Removing the bladder (cystectomy)
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In this operation, the whole bladder is removed. In men, the prostate gland, part of the urethra and the lymph nodes close to the bladder are also taken away. In women, the bladder, womb, ovaries, cervix, urethra, part of the vagina and nearby lymph nodes are removed. Men are usually unable to get or maintain an erection (impotent) after this operation. Women who have this operation may find sexual sensation significantly different, or intercourse may not be possible for them. We have more information about the effects of surgery on your sex life and fertility.
Minimally invasive (keyhole or laparoscopic) surgery
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In some situations, it may be possible to have minimally invasive (keyhole) surgery to remove some or all of your bladder. In this type of surgery, only small cuts are made instead of one large cut. (Generally about three small cuts and one slightly larger cut are made).
The surgeon uses a special instrument called a laparoscope to see and work inside the abdomen. The laparoscope is a thin tube with an eyepiece at one end and a light and a magnifying lens at the other. It is put into the abdomen through a small cut in the skin.
Sometimes the surgeon uses a machine (robot) during minimally invasive surgery. The robot holds the instruments and can make very precise and delicate movements but is controlled by the surgeon.
Keyhole surgery should be carried out by surgeons with specialist training and experience in using laparoscopic techniques. Your surgeon will be able to discuss the benefits and disadvantages of this type of surgery with you.
When your bladder is removed, an alternative method for storing and passing urine will be constructed. There are several different ways of replacing the bladder. Your surgeon will explain which one is most suitable for you and give you more information about what is involved. These operations are only carried out by specialist surgeons.
Urostomy (ileal conduit)
This is the most common operation, and it means that in the future, your urine will be collected in an external bag. During the operation, the surgeon removes a section of your small bowel and joins the two ureters to one end of it. They bring the other open end of the bowel out through a small opening in the skin of your abdomen.
The ureters carry urine from your kidneys to the piece of bowel. The piece of small bowel (ileum) acts as a channel (conduit) to take the urine to the surface of the abdomen. This is why this operation is sometimes called an ileal conduit. The small opening on the surface of the abdomen through which the urine now passes out of the body is called a stoma.
A flat, watertight bag is placed over the stoma to collect your urine. It’s kept in place with a special type of adhesive. The bag will fill with urine, and you’ll need to empty it regularly. Your specialist stoma nurse will show you how to take care of it. We have more information on living with a urostomy.
Continent urinary diversion (internal pouch)
With this type of operation you don’t need an external bag to collect your urine. Your surgeon uses a piece of your bowel to make a pouch that can store urine inside your abdomen. The ureters are attached to the pouch and carry urine from your kidneys to the pouch.
How the pouch is emptied of urine will depend on the type of operation you have. The pouch may be connected to an opening (stoma) made on the tummy wall. This operation is called a continent cutaneous urinary diversion. Alternatively the pouch can be connected to the urethra. This is called a neobladder.
Bladder reconstruction is not suitable for everyone. Your doctor will explain if it is appropriate for you.
Continent cutaneous urinary diversion
If you have this type of operation the internal pouch that replaces your bladder is connected to your tummy (abdominal) wall with a small opening called a stoma. You empty urine from the pouch through the stoma using a tube (catheter). This is called self-catheterisation, and you will need to do it about five times a day. Although you may feel worried about doing this at first, most people find they soon get used to emptying the pouch and caring for their stoma. Your specialist stoma nurse will show you how.
Neobladder (New bladder)
In this type of operation instead of making a stoma the surgeon connects the new pouch to your urethra. This means you’ll be able to pass urine in a similar way to before the operation. You flex your abdominal muscles to empty the pouch. You will need to remember to do this at regular intervals, as you will have lost the nerves that tell you when your bladder is full. You may also need to pass a catheter up your urethra (self-catheterise) to empty the bladder sufficiently. Your specialist nurse will teach you how to do this.
There’s a small risk that the cancer could come back in the urethra. If you have this type of operation you’ll have a test every year to check your urethra in addition to other routine checks for bladder cancer.
It is sometimes possible to divert the urine into the rectum so that both urine and stools are passed through the back passage (rectum). If this is done, you won’t need a urostomy bag or a catheter to drain the urine.
You may be nursed in the intensive care or high-dependency unit immediately after your operation. This is routine in many hospitals and does not mean your operation has gone badly or that there have been complications.
The nurses will encourage you to start moving about as soon as possible after your operation. This is an essential part of your recovery, as it helps to prevent problems such as chest infections or blood clots. If you have to stay in bed, the nurses will encourage you to do regular leg movements and deep breathing exercises. A nurse or a physiotherapist can help you do the exercises.
Drips and drains
After the operation you may have some of the following in place for a short time:
a drip (intravenous infusion), which can be used to give you fluids until you are able to eat and drink again and can also give you painkillers, if needed
a drainage tube in your wound/wounds to prevent swelling and allow the wound to heal properly
a nasogastric (NG) tube, which passes down your nose into your stomach or small bowel and allows fluids to be removed so that you don’t feel sick – it’s usually taken out within 48 hours
a fine tube that goes into your back (epidural) and may be used to give you drugs that numb the nerves and stop you from feeling pain.
After your operation, you’ll need painkilling drugs for a few days. These may be given into a vein (intravenously), into the space around your spinal cord (epidural), into your muscle (intramuscularly) or as tablets.
To begin with you may be given intravenous painkilling drugs through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller. You may also have a hand control with a button you can press if you’re in pain. This is called patient-controlled analgesia (PCA). It’s designed so that you can’t overdose, so it’s fine to press it whenever you are uncomfortable.
Some people are given painkilling drugs into the space around the spinal cord (epidural) to numb the nerves. The drugs are often given through a syringe and tubing attached to an electronic pump.
If you’re in pain, let your nurses and doctors know as soon as possible. This will help them to give you the combination and dose of painkillers that’s right for you.
How long you’re in hospital for after your operation will depend on the type of operation you’ve had, but it can range from 7-14 days.
If you think that you might have problems when you go home - if you live alone or have flights of stairs to climb, for example - tell your nurse or social worker. They can arrange help for you before you leave hospital.
Your doctor will advise you about how soon you’ll be able to get back to doing normal things, like work, driving, shopping, gardening or playing sport. This will vary depending on the surgery you’ve had and on you as a person.
Before you leave hospital, you’ll be given an outpatient appointment for a check-up. This will be a few weeks after your surgery and is a good time to discuss any problems you may have after your operation.
Changes to your appearance
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You may be worried about adapting to changes in how your body looks and how you may feel about your body after any surgery. This is a normal reaction. Over the years we all develop an image in our minds about what our bodies look like. Although we may not be completely satisfied with that image, most people are used to the way they see themselves. It can be upsetting to have that changed permanently by surgery.
You may also be concerned about the effect that the surgery will have on your relationships. You may be worried about rejection by your current or future partner, having sex with your partner or starting a new relationship.
Many people find that they feel reassured once they’ve talked about their fears with their partner. Talking about your feelings can also help you better understand what worries you the most. It gives other people the chance to understand more about how you are feeling too.
You can also talk to your doctor or nurse about your concerns, or you may like to contact one of our cancer support specialists.