What is a cystectomy?
Cystectomy is a complex surgical procedure in which a surgeon removes some or all of your urinary bladder — the organ below your kidneys and above your urethra that holds your urine (pee) before it leaves your body.
Surgeons usually perform a cystectomy to treat bladder cancer. However, they sometimes perform a cystectomy to treat benign (not cancerous) conditions that affect the bladder and urinary system.
Another name for a cystectomy is bladder removal surgery.
Is a cystectomy major surgery?
Yes, a cystectomy is major surgery. It removes all or part of your urinary bladder.
Can a person live without a bladder?
Yes, you can live without a bladder, but you’ll need a new reservoir to hold pee that your kidneys produce. However, if a surgeon removes your entire bladder, there’s an adjustment period as you become more comfortable with a new way to relieve yourself. You can still do many of the activities that you did before surgery.
Why is a cystectomy done?
Surgeons mostly perform cystectomies to treat bladder cancer. However, they may also recommend the procedure to treat congenital conditions (conditions you’re born with) or other conditions that affect your urinary system.
What happens before a cystectomy?
Before a cystectomy, you’ll meet with a healthcare provider. They’ll check your general health and take your vitals (temperature, pulse and blood pressure). They’ll also talk to you about which surgical approach they’ll use to remove your bladder. They may remove part of your bladder (partial cystectomy) or your entire bladder (radical cystectomy):
- Partial cystectomy. Your surgeon removes only part of your bladder. If they’re performing a partial cystectomy to treat cancer, they’ll usually remove nearby lymph nodes as well to determine whether any cancer has spread beyond your bladder. Lymph nodes are small bundles of tissue that filter your body’s lymph fluid (clear fluid that contains white blood cells and keeps your body’s cells moist) and produce immune system cells. Your surgeon repairs the remaining bladder, and it stays in your body.
- Simple cystectomy. Your surgeon will remove your bladder, but not any of the surrounding structures. This approach treats benign bladder conditions such as neurogenic bladder, radiation cystitis, urinary fistula and severe interstitial cystitis.
- Radical cystectomy. Your surgeon removes your entire bladder and nearby lymph nodes. In men and people assigned male at birth (AMAB), surgeons almost always cut the vas deferens and remove the prostate and seminal vesicles. In women and people assigned female at birth (AFAB), your surgeon often removes your uterus, fallopian tubes, ovaries and cervix. They occasionally remove part of the vaginal wall, too.
Tell your healthcare provider about any prescription or over-the-counter (OTC) medications you’re taking. These include herbal supplements. Aspirin, anti-inflammatory drugs, certain herbal supplements and blood thinners can increase your risk of bleeding. Be sure to check with a healthcare provider before stopping any medications.
Tell your healthcare provider about any allergies you have as well. Include all known allergies. These include medications, skin cleaners like iodine or isopropyl alcohol, latex and foods.
Your healthcare provider will also give you specific directions on eating and drinking before your cystectomy. You shouldn’t eat or drink anything after midnight the night before your surgery. If you must take medications, you should take them with a small sip of water.
What happens during a cystectomy?
A special team of healthcare providers will perform a cystectomy. The team typically includes:
- A urologist.
- An anesthesiologist.
The anesthesiologist will sedate you (put you under) with general anesthesia. You won’t be awake, won’t move and won’t feel any pain during the procedure.
Your urologist will perform your cystectomy using one of two different surgical approaches:
- Open cystectomy. Your urologist accesses your bladder and the tissues around it with one, long vertical surgical incision (cut) of about six to seven inches (15 to 18 centimeters) between your belly button and pubic bone. They’ll then insert their gloved hands into your body cavity through the incision to perform the operation.
- Minimally invasive (laparoscopic or robotic) cystectomy. Your urologist will first inflate (insufflate) your abdomen with carbon dioxide to create a working space. They’ll then make five to six very small incisions (about half an inch or less) in your abdomen (belly area) so that they can insert long, thin instruments, including a camera, into your body cavity. Laparoscopic surgery means your urologist uses these instruments to perform the surgery with these tools. Robotic surgery involves attaching the instruments to a surgical robot that your urologist controls through a surgical console (controller). A surgical robot enhances the operation by providing three-dimensional vision as well as more precise movements.
After removing some or all of your bladder, your urologist will perform reconstructive surgery. Reconstructive surgery creates a new way to store pee and remove it from your body. If your urologist performs a complete cystectomy, they’ll reconstruct your urinary tract in one of three ways so that the pee you produce can leave your body. These methods include:
- Ileal conduit. Your urologist disconnects a short section of your small intestine (ileum). The ureters (the tubes that carry pee from your kidney to your bladder) attach to one end of the ileum. The other end attaches to an opening in your skin (stoma). The stoma is usually close to the right side of your belly button. A plastic bag (ostomy bag) goes over the stoma to collect pee.
- Continent cutaneous diversion. Your urologist creates a reservoir out of part of your small and large intestines to store pee. Your ureters attach to one end of the reservoir, and the other end of the reservoir connects to a stoma in your abdomen. You must periodically empty the reservoir by inserting a small drainage tube (catheter) into the stoma. You don’t have an ostomy bag outside your body with a continent cutaneous diversion.
- Neobladder. Your urologist uses a long piece of your small intestine to create a reservoir to store pee. Your ureters attach to one end of the reservoir. The other end of the reservoir connects to your urethra. You must periodically empty the reservoir by relaxing your pelvic muscles and tensing your abdominal muscles. Some people with neobladders need a urinary catheter to help drain pee.
How long does cystectomy surgery take?
A cystectomy takes approximately six hours to perform.
What happens after a cystectomy?
After a cystectomy, a healthcare provider will stitch your incisions and cover them with bandages.
The anesthesiologist will stop putting anesthesia into your body. You’ll be conscious (awake) within a few minutes, but you’ll likely still feel groggy.
You’ll then move to a recovery room. Healthcare providers will wait for you to wake up more fully and track your overall health. Once you fully wake up, providers will treat your pain. You may need pain medication and management techniques.
How long is a hospital stay for bladder removal?
Your hospital stay depends on the type of cystectomy you have.
You’ll typically need to stay in the hospital for at least one day after a laparoscopic or robotic cystectomy.
For an open cystectomy, your hospital stay is longer. You may need to stay in the hospital for up to a week.
During your hospital stay, providers will monitor your recovery and make sure you’re beginning to heal and aren’t having issues with pain management. If you need an ostomy bag, they’ll also teach you how to attach, empty and change it.
Care at Cleveland Clinic
- Bladder Cancer Treatment
- Find a Doctor and Specialists
- Make an Appointment
Risks / Benefits
What are the advantages of a cystectomy?
The main advantage of a cystectomy is that it treats bladder cancer or another noncancerous condition that affects your bladder or urinary system.
What are the risks or complications of a cystectomy?
Like any major surgery, a cystectomy poses risks. These risks include:
- Blood clots.
- Bowel complications.
- Scar tissue that blocks the flow of pee from your kidneys.
- Organ damage.
- Anesthesia risks.
- Healing problems.
- Fluid buildup at surgical sites (seroma).
As you recover, you may have a poor appetite and abnormal bathroom habits, including constipation, diarrhea or both. You may also have changes in how you pee after a cystectomy. Your bladder is smaller after a partial cystectomy, so you may need to go to the bathroom more often. It’s also normal to have mucus in your pee. If you have a radical cystectomy, your ability to pee depends on the type of reconstructive surgery you have.
For some men and people AMAB, a cystectomy may cause sexual side effects. You may have difficulty getting and maintaining an erection.
Women and people AFAB may also experience sexual side effects. Intercourse is still possible, but it may cause discomfort if the urologist removes part of your vagina. Some people may have nerve damage. Nerve damage may limit your ability to become sexually aroused and achieve orgasm.
Recovery and Outlook
What is the recovery time?
A complete recovery may take several weeks to months.
Your recovery depends on the type of bladder removal surgery you have. Typically, most people who have a partial cystectomy will have a shorter recovery period than people who have a radical cystectomy.
How is life after a cystectomy?
After a few weeks, you should be able to return to work or school and resume light physical activities.
After you recover from a cystectomy, it may take time to adjust to the changes to your body. If you have an ostomy bag, the following tips may help you adjust faster:
- Empty the bag before it’s half-full to keep it flat.
- Use warm water, a washcloth and mild, fragrance-free soap to clean and rinse the skin around your stoma.
- After you wake up, change your pouch before you drink anything to help prevent dripping.
- After you empty your bag, add a pouch of ostomy deodorant to help control odors.
- Use ostomy powder when you change your bag to reduce skin irritation.
Some people find it helpful to be upfront with others about their ostomy bag. Ultimately, it’s up to you to decide how open you want to be about your surgery and ostomy. Your healthcare provider can recommend how and when to explain your surgery and ostomy bag to others.
When to Call the Doctor
When should I see my healthcare provider?
After a cystectomy, contact your healthcare provider right away if you notice any of the following symptoms:
- Signs of infection, including fever, chills and dark, cloudy pee.
- Long-lasting nausea and vomiting.
- Heavy bleeding at your surgical sites.
- Increasing discoloration, swelling, pain or pus from your surgical sites.
- Black, brown or dark purple skin discoloration of your stoma.
- Excessive pain that you can’t control with your prescribed medications.
- Inability to pee or difficulty draining your pee from your diversion.
A note from Cleveland Clinic
A cystectomy is a surgical procedure that removes part or all of your urinary bladder. It can be a stressful procedure and recovery. There may be an adjustment period as you get used to the changes in your body and your daily routines. Your healthcare providers will help you adjust, answer all of your questions and offer the best recommendations for your long-term health and quality of life.
Surgeons most often recommend it to treat bladder cancer. If they remove your entire bladder, they'll create a new way for urine to leave your body. Risks include bleeding, infection and sexual side effects. Recovery may take several weeks to months.How risky is cystectomy? ›
Because of this, cystectomy carries with it certain risks, including: Bleeding. Blood clots in the legs. Blood clots that travel to the lungs or heart.How long does it take to fully recover from a cystectomy? ›
It can take 8 to 12 weeks to recover from a radical cystectomy. Even when you are 'healed' it can still be several months before you feel completely recovered. There are some things you can do to help your recovery. You might find your bowels do not work the same way they did before your surgery.How do you pee after cystectomy? ›
Your surgeon makes a new opening called a stoma on your tummy (abdomen) for the urine to pass through. This way of collecting urine allows you to control (be continent) when urine comes out. You don't have to wear a bag to collect urine. You pass a thin tube (catheter) into the stoma to pass urine.What is the survival rate after cystectomy? ›
The most effective treatment for muscle-invasive bladder cancer is radical cystectomy combined with pelvic lymph node dissection. Studies in Western countries have reported 5-year survival rates of 54.5%–68%, in bladder cancer patients who underwent radical cystectomy.How long are you in hospital after a cystectomy? ›
You'll typically need to stay in the hospital for at least one day after a laparoscopic or robotic cystectomy. For an open cystectomy, your hospital stay is longer. You may need to stay in the hospital for up to a week.Is a cystectomy major surgery? ›
The standard of care for patients with muscle-invasive bladder cancer is radical cystectomy, the surgical removal of the bladder. However, this is a major operation, with a significant risk of complications and potentially, even death.Can you live a normal life after bladder removal? ›
With enough time, you should be able to do almost everything you did before. Even if you now use a urostomy bag (to collect your urine), you can go back to work, exercise, and swim. People might not even notice you until you tell them.What can you not do after bladder surgery? ›
Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for about 3 weeks, or until your doctor says it is okay. For about 3 weeks, avoid lifting anything that would make you strain.Are cystectomy painful? ›
A cystectomy is surgery to remove part or all of the bladder. The surgery is mainly used to treat bladder cancer. After surgery, your belly will be sore. You will probably need pain medicine for 1 to 2 weeks.
The five-year survival rate after cystectomy is about 65 percent.How long do you need a catheter after bladder surgery? ›
You will have a urinary catheter for about 3 weeks. Your doctor or nurse will tell you how to care for it.How long does bladder cystectomy surgery take? ›
A cystectomy: Lasts about 3-6 hours. Results in painful recovery. Requires a hospital stay of 5-12 days.What is the 10 year survival rate after radical cystectomy? ›
Ten-year disease-free survival rates as high as 92% have been reported for patients undergoing radical cystectomy for T1 tumors, compared with the 64% 10-year disease-free survival rate for muscle-invasive disease observed in the same series.What is the difference between cystectomy and radical cystectomy? ›
Partial cystectomy takes out part of the bladder. Simple cystectomy takes out all of the bladder. Radical cystectomy takes out all of the bladder. It also takes out nearby lymph nodes and all or part of the urethra.What are common complications after radical cystectomy? ›
These complications include urinary tract infection, deterioration in renal function, calculi formation, metabolic complications, voiding dysfunction, and recurrence of disease.What is the bag after bladder removal? ›
Urostomy pouches are special bags that are used to collect urine after some types of bladder surgery. Instead of going to your bladder, urine will go outside of your abdomen into the urostomy pouch. The surgery to do this is called a urostomy. Part of the intestine is used to create a channel for the urine to drain.Is cystectomy a minor surgery? ›
Is ovarian cystectomy a major surgery? It depends on what type of surgery you have. If your surgeon can perform the procedure laparoscopically, it's minimally invasive and you'll likely return to your typical activities within two or three weeks.What is the pain relief after bladder surgery? ›
Immediately after surgery, you might have painkillers in one of the following ways: painkillers through a drip into the bloodstream - you control this by pressing a button when you have pain - this is called patient controlled analgesia (PCA) local anaesthetic through a small thin tube into your back (an epidural)What causes a cyst on your bladder? ›
Bladder cysts can be caused by a rare condition called cystitis cystica. It is associated with persistent inflammation in the urinary tract, possibly due to irritation or bacteria in the bladder.
Early complications include urine leakage, urinary obstruction, postoperative fluid collection (eg, urinoma, hematoma, lymphocele, or abscess), and fistula formation. Late complications include ureteroileal anastomotic stricture, stomal stenosis, conduit stenosis, and urolithiasis.How do you take care of a cystectomy? ›
It is important to get out of bed to a chair and to walk as soon as possible after surgery. Walking helps with wound healing and return of bowel function. It also helps prevent pneumonia, blood clots in the leg or lung and infections. Try to walk six times a day.How do you pee after bladder surgery? ›
You healthcare provider may also start you on medication to relax your urethra to make it easier for your bladder to empty. This medication, called an alpha blocker, is often given to men to relax their prostates. It can also be given for a short time period to men and women to help them urinate after surgery.Is it painful to have your bladder removed? ›
Bladder removal surgery, or cystectomy, is the removal of the urinary bladder. After surgery, there may be pain and it can take several weeks to recover. A person will also need to adapt to using a new pathway for urine to leave the body. A person should prepare fully before going into bladder removal surgery.Is bladder surgery high risk? ›
Risks of bladder surgery are like those with any major surgery: Reactions to anesthesia. Bleeding from the surgery. Blood clots in the legs or lungs.Can you walk after bladder surgery? ›
Many women are able to walk for 30 to 60 minutes after 3 to 4 weeks. It is common to experience fatigue after surgery. Having a daily lie down and resting with your feet up can help.What not to eat after bladder removal? ›
For the first weeks, avoid fats and high-fibre foods, like popcorn and raw or undercooked vegetables.How do you sleep after a cystectomy? ›
Sleeping in a semi-upright position is recommended, using a few pillows to elevate the head and shoulders to avoid putting pressure on the abdominal area. Avoid sleeping on your stomach or the side where the incisions were made.Will I pee myself after catheter removal? ›
Once the catheter is removed, most men leak urine for a period of time. The leakage occurs mainly due to stress incontinence - failure of the urethral sphincter to close properly (Ficazzola 1998).What are the side effects of bladder surgery? ›
Bleeding, infection and internal damage are typically a risk in any surgery.
Urinary retention is a common complication that arises after a patient has anesthesia or surgery. The analgesic drugs often disrupt the neural circuitry that controls the nerves and muscles in the urination process.What is the recurrence rate after radical cystectomy? ›
Local recurrence rate ranges between 30 and 54%. Distant recurrence is not often standardized and is reported in up to 50% of cases. The overall 5-year recurrence-free survival rates from 58 to 81%.What is the complication rate of radical cystectomy? ›
Radical cystectomy (RC) is a very complex urologic procedure. Despite improvements in practice, technique and process of care, it is still associated with significant complications, including death, with reported postoperative mortality rates ranging from 0.8% to 8%.What are the contraindications for cystectomy? ›
Contraindications to radical cystectomy include the following: Bleeding diathesis. Evidence of gross, unresectable metastatic disease (unless performed for palliation) Medical comorbidities that preclude operative intervention (eg, advanced heart disease, poor pulmonary mechanics, advanced age)What is the survival rate of radical cystectomy with ileal conduit? ›
The median survival was 3.5 years. Our results demonstrate that radical cystectomy and ileal conduit urinary diversion should not be withheld from patients on the basis of age.What is the comparison of major complications at 30 and 90 days following radical cystectomy? ›
The rate of major complication significantly differed at 30 and 90 days (14.4% [confidence interval (CI): 12.4%-16.9%] vs 21.7% [CI: 19.2%-24.4%] respectively, P ≤ . 0001). Deaths were recorded for 9 out of 969 (0.9%) patients at 30 days and 25 out of 969 (2.6%), cumulatively, at 90 days.How many lymph nodes are removed during a radical cystectomy? ›
They concluded that regardless of the tumor stage, at least 14 lymph nodes should be excised in patients undergoing radical cystectomy.What are the late complications of cystectomy? ›
Late complications include ureteroileal anastomotic stricture, stomal stenosis, conduit stenosis, and urolithiasis. Although not directly related to ileal conduits, ureteroarterial fistula can occur in patients with an ileal conduit.How do you pee when your bladder is removed? ›
A radical cystectomy also involves creating a urinary diversion since the bladder is removed during the procedure. This urinary diversion involves using parts of the intestines to allow urine to pass from the kidneys to either an ileal conduit, urinary reservoir pouch called an Indiana Pouch, or a neobladder.Is there an alternative to bladder removal? ›
Trimodal chemoradiation – This is an alternative approach to removal of the bladder, in which a thorough, complete TURBT is performed and then followed with systemic chemotherapy and radiation therapy to the bladder.
Most people are able to urinate in a normal way again after treatment. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems.How many hours is bladder surgery? ›
Bladder removal is a major surgery. This surgery can take anywhere between four and six hours, depending upon your prior surgical history, or maybe other intra-operative findings that we find during the operation.How successful is radical cystectomy? ›
(See "Urinary diversion and reconstruction following cystectomy", section on 'Recurrent urothelial cancer'.) Patients with urethral recurrence have a five-year disease-free survival from 47 to 63 percent and an overall survival from 40 to 74 percent .How long does a bladder cystectomy take? ›
A cystectomy: Lasts about 3-6 hours. Results in painful recovery. Requires a hospital stay of 5-12 days.What is the difference between simple cystectomy and radical cystectomy? ›
Simple cystectomy takes out all of the bladder. Radical cystectomy takes out all of the bladder. It also takes out nearby lymph nodes and all or part of the urethra. That's the tube that carries urine from your bladder and out of your body.