When facing a complex urological diagnosis, terms like “cystectomy” can sound intimidating.
However, understanding what the procedure involves, why it is performed, and what to expect during recovery can significantly demystify the process.
At Urology Specialist, we believe that informed patients are empowered patients. Here is a comprehensive guide to everything you need to know about a cystectomy.
What is a Cystectomy?
A cystectomy is a major surgical procedure to remove all or part of the urinary bladder.
Depending on the extent of the disease, your surgeon will recommend one of two types:
- Partial Cystectomy: Only the damaged section of the bladder is removed. This is only suitable if the disease is confined to one isolated area of the bladder wall.
- Radical Cystectomy: The entire bladder is removed, along with nearby lymph nodes and parts of surrounding reproductive organs (such as the prostate and seminal vesicles in men, or the uterus, ovaries, and part of the vagina in women).
Why is it Performed?
The most common reason for a radical cystectomy is bladder cancer—specifically, cancer that has grown into the deeper muscle wall of the bladder (muscle-invasive bladder cancer) or recurrent, aggressive non-invasive bladder cancer.
Less frequently, a cystectomy may be performed to treat other severe conditions, such as:
- Advanced neurological disorders affecting bladder function (neurogenic bladder).
- Severe interstitial cystitis (chronic bladder wall inflammation) that has failed all other treatments.
- Severe damage to the bladder from radiation therapy or trauma.
How Do You Urinate After the Bladder is Removed?
Because a radical cystectomy removes your body’s natural storage tank for urine, the surgical team must create a new way for your body to store and eliminate waste. This process is called urinary diversion. There are three primary methods:
- Ileal Conduit (Urostomy): A small piece of your small intestine (ileum) is used to create a tube (conduit). The ureters—the tubes that drain urine from the kidneys—are connected to this piece of bowel. The other end is brought out through the abdomen wall to create a small opening called a stoma. Urine drains continuously into an external pouch attached to your skin.
- Neobladder Reconstruction: A piece of the intestine is reshaped into a new, internal pouch (a “new bladder”) and stitched directly to the urethra. This allows you to urinate relatively normally through your natural anatomy, though it takes time and physical therapy to train the new pouch.
- Continent Urinary Diversion: An internal pouch is created from the intestine, but instead of connecting to the urethra, it connects to a small stoma on the abdomen. A special valve prevents urine from leaking out automatically. Instead, you empty the pouch several times a day by inserting a thin tube (catheter) through the stoma.
Surgical Approaches: Traditional vs. Robotic
A cystectomy can be performed via traditional open surgery or through minimally invasive techniques:
The Advanced Standard: Many modern cystectomies are performed using robotic-assisted laparoscopy.
Using precise robotic instruments controlled by the surgeon through tiny keyhole incisions, this approach generally results in less blood loss, less post-operative pain, and a faster return to daily activities compared to large open incisions.
Recovery and Life After Surgery
A cystectomy is a significant operation that typically requires a hospital stay of 5 to 10 days. The initial recovery phase at home takes about 6 to 8 weeks.
Adapting to a urinary diversion requires patience and practice, but most patients successfully return to active, fulfilling lives – including swimming, exercising, working, and travelling. A dedicated stoma therapist and your urology team will guide you through every step of this adjustment period.
Dr Arianayagam is a very experienced urologist and has extensive experience in dealing with all urological conditions.
If you have any further questions about Urologic Cancer and would like to book an appointment, please feel free to contact or call on 1300 307 990.
