Surgery for invasive and advanced bladder cancer

Surgery usually involves removing the whole bladder. This operation is called a radical cystectomy. It can be used to treat invasive and locally advanced bladder cancer. Sometimes it is used for advanced bladder cancer.

During the operation, the surgeon will make a new way for you to pass urine. This is called a urinary diversion. Usually the surgeon will also remove areas close to the bladder. Your doctor can tell you what might be removed and how it might affect you.

Bladder surgery may affect your fertility and your sex life. You doctors can explain more about this to you.

Some people have their bladder removed using laparoscopic (keyhole) surgery. This involves having several small cuts rather than one large one. You usually recover more quickly with keyhole surgery.

Some people may have only the tumour removed. This a called a transurethral resection of bladder tumour or TURBT. And some may have just part of their bladder removed. This operation is called a partial cystectomy. These operations are only suitable for a small number of people.

Surgery

Surgery usually involves removing your whole bladder. This is called a radical cystectomy.

Cystectomy is used to treat invasive or locally advanced bladder cancer. It may also be used in advanced bladder cancer, when the cancer is only in a small number of lymph nodes close to the bladder.

When your whole bladder is removed, the surgeon will make a new way for you to pass urine. This is called a urinary diversion. It’s done at the same time as the operation to remove your bladder. There are different types of operation to make a urinary diversion.


Other types of surgery

Some people may have the bladder tumour removed without removing the bladder. This is only suitable for invasive bladder cancer which is only in the muscle layer. This operation is called a transurethral resection of bladder tumour (TURBT). You will have chemotherapy and radiotherapy after surgery.

Some people may have part of their bladder removed. This is called a partial cystectomy. It is only suitable for a small number of people with rarer types of bladder cancer.

Your surgeon will explain if any of these operations are suitable for you.


Removing the bladder (cystectomy)

Your operation will usually involve removing some areas close to the bladder as well as the whole bladder. If you are having an operation to make a new bladder (bladder reconstruction), your urethra won’t be removed.

Your surgeon or specialist nurse will explain what will be removed and how this will affect you. This includes possible effects on your sex life and fertility. If you are worried about your fertility, speak to your doctor or specialist nurse before your treatment starts.

Cystectomy is a major operation. Your doctor will check your general health to make sure you are fit enough for the operation.

Men

In men, the bladder, prostate gland, seminal vesicles (where semen is stored) and sometimes part or all of the urethra are removed. The lymph nodes (glands) close to the bladder are also taken away.

After a cystectomy, you may not be able to get or keep an erection (erectile dysfunction). This is because the prostate gland is removed and the surrounding nerves may be damaged.

Talk to your doctor or specialist nurse about this before surgery. They can explain about treatments that may help. We have more information about your sex life after bladder surgery.

After the operation, you won’t be able to produce semen. This means you will be infertile. If you are worried about this, you may be able to store sperm before treatment starts.

Women

In women, the bladder, nearby lymph nodes and the urethra are removed. Usually the womb, ovaries, cervix and part of the vagina are also removed. In women who haven’t had their menopause, the ovaries and womb may be left in place.

After surgery, women may find sexual sensation very different. Removing part of the vagina makes it shorter. This can sometimes mean penetrative sex is more difficult, uncomfortable or no longer possible. Speak to your doctor or specialist nurse if you are worried about this. We have more information about the effects of bladder surgery on your sex life.

Having your bladder removed is a major operation, and you may find the thought of it scary. If you would like to talk to someone, you can call our cancer support specialists on 0808 808 00 00.

It’s a major op, requiring months to fully regain energy and fitness. However, I had no major complications, started back at work after three months and am now managing fine.

Tess


Laparoscopic (keyhole) surgery

Some people have laparoscopic (keyhole) surgery to remove their bladder. The surgeon makes several small cuts in your tummy (abdomen) rather than one large cut. This means that you recover from your surgery more quickly. Keyhole surgery is not suitable for everyone.

During keyhole surgery, the surgeon uses an instrument called a laparoscope to see and work inside the tummy. The laparoscope is a thin tube with a tiny camera on the end. It sends pictures of the inside of the tummy to a computer screen. The surgeon puts the laparoscope into the tummy through a small cut in the skin.

Sometimes the surgeon may use a machine (robot) during laparoscopic surgery. This is called robotically assisted surgery. The robot holds the instruments which are controlled by the surgeon. This makes the surgery very precise and may help reduce the risk of complications.

Laparoscopic (keyhole) surgery needs to be carried out by surgeons with specialist training. You may have to travel to a different hospital to have it.

Your surgeon will be able to discuss the benefits and disadvantages of this type of surgery with you.

Making a urinary diversion can also sometimes be done using keyhole surgery, but standard methods of surgery are usually used for this.

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