Radical Cystectomy – Bladder Cancer Surgery

Radical cystectomy is major surgery to remove the urinary bladder and appropriate nearby tissues and lymph nodes to treat selected bladder cancers. A new urinary diversion is also created.

Yes. It is major abdominal and pelvic surgery, often involving bowel reconstruction. Complications can be serious, and recovery commonly takes several weeks or longer.

No. Many bladder cancers can be treated with TURBT, intravesical therapy and surveillance. Radical cystectomy is considered for muscle-invasive and selected very-high-risk cancers.

BCG is an established treatment for certain high-risk non-muscle-invasive bladder cancers. However, cystectomy may be recommended when cancer is very high risk or BCG-unresponsive. Treatment depends on the exact cancer findings.

Selected patients may be suitable for bladder-preserving trimodality therapy, combining TURBT, chemotherapy and radiotherapy. It requires careful selection and long-term cystoscopic follow-up. Your team should explain whether it is appropriate.

Some patients benefit from systemic treatment before cystectomy, commonly involving cisplatin-based chemotherapy. Immunotherapy may also be part of selected perioperative regimens. Suitability and availability should be discussed with an oncologist.

In men, standard radical cystectomy usually includes removal of the prostate and seminal vesicles. This may be called radical cystoprostatectomy.

The extent of surgery depends on cancer location and surgical planning. Nearby reproductive organs or part of the vagina may be removed. In selected patients, some structures may be preserved when oncologically safe.

Regional pelvic lymph node removal is normally included in radical cystectomy for bladder cancer. The nodes are examined to help establish cancer stage.

Robotic-assisted radical cystectomy is performed in experienced centres. Open surgery is also an established approach. The best option depends on individual circumstances and the surgical team.

The operation commonly takes several hours. Total time depends on surgical approach, urinary diversion, anatomy and any additional procedures required.

Many patients remain in hospital for approximately one to two weeks. Admission may be shorter or longer depending on bowel recovery, complications and how confidently you can manage the diversion.

Major physical recovery commonly takes six to eight weeks or longer. Regaining stamina, adapting to a stoma or training a neobladder may take several months.

An ileal conduit requires a stoma and external urine collection bag. Other diversions, such as a neobladder or continent pouch, may be possible in selected patients.

An ileal conduit uses a short segment of small bowel to connect the ureters to an abdominal stoma. Urine drains into a bag worn over the stoma.

A neobladder is an internal urine reservoir constructed from bowel and connected to the urethra. It allows urine to leave through the usual opening but requires training to empty.

No. A neobladder does not have the same nerves or muscle function as the original bladder. Patients learn a scheduled emptying routine, and leakage or difficulty emptying can occur.

Not necessarily. Continence often improves with training and recovery, but day-time or night-time leakage can persist. Some patients require pads or intermittent catheterisation.

Neobladder surgery is an option for suitable patients. Urethral cancer involvement, kidney function, bowel disease and other factors can limit suitability. Discuss your preferences with the surgical team.

This is an internal urine reservoir created from bowel. It is emptied by passing a catheter through a small abdominal stoma several times a day.

A stoma is a surgically created opening on the abdomen. For an ileal conduit, urine passes through the stoma into an attached collection bag.

The stoma itself generally has little or no pain sensation, but the surrounding skin can become irritated or sore. A stomal therapy nurse can assist with appliance fitting and skin care.

Many patients return to travel, exercise and recreational activities once recovered. Appropriate appliances, spare supplies, hydration and advice about abdominal support can help with confidence and comfort.

Many people can swim with a correctly fitted urostomy appliance once the wounds have fully healed and the treating team has cleared them for swimming.

Temporary catheters, ureteric stents or drains may be used following urinary reconstruction. The type and removal timing depend on the diversion and surgical findings.

Temporary ureteric stents may support drainage while the connections between the ureters and intestinal urinary diversion heal. The surgical team will explain when removal is planned.

Erectile dysfunction is common after radical cystectomy in men. Selected nerve-preserving procedures may help maintain function when oncologically appropriate, but recovery is not guaranteed. Treatments may be available after surgery.

Yes. Surgery may change vaginal anatomy, pelvic support, sensation or hormonal function. Some patients experience pain with intercourse or other sexual difficulties. Specialist support may be helpful.

Fertility may be permanently affected by the surgery and associated cancer treatment. Sperm banking or other fertility preservation options should be discussed before treatment when relevant.

Urinary infections can occur after diversion. Bacteria may be present in urine from an intestinal diversion without causing illness. Fever, flank pain or feeling unwell requires medical assessment.

Yes. Kidney function can change after cystectomy due to infection, obstruction, dehydration or other factors. Long-term blood tests and appropriate imaging are important.

Some intestinal urinary diversions can affect vitamin B12 absorption over time. Periodic monitoring may be recommended based on the bowel segment used and your clinical circumstances.

Radical cystectomy carries a risk of blood clots. Some patients are prescribed anticoagulant injections for up to four weeks or longer according to the hospital's protocol and individual risk.

Yes. Cancer may recur locally or elsewhere in the body even after bladder removal. Long-term surveillance is based on the final pathology and overall risk.

Some patients require surveillance alone. Others may benefit from additional chemotherapy, immunotherapy or other oncology treatment depending on pathology, stage and previous therapy.

Bring your GP referral, TURBT pathology, cystoscopy reports, CT or MRI results, medication list, kidney function blood tests and details of previous BCG, chemotherapy or radiotherapy if applicable.