Cystectomy (removing the bladder)

A cystectomy is an operation to remove the bladder.

This is one of the main treatments for muscle-invasive or locally advanced bladder cancer. The aim is to cure the cancer. You may have chemotherapy before or after the operation. These anti-cancer drugs help reduce the risk of cancer coming back.

You may also be offered a cystectomy for non-muscle-invasive bladder cancer if:

• you have a high-risk, non-muscle-invasive bladder cancer
• BCG treatment is not working
• the cancer keeps coming back even after treatment.

Rarely, a cystectomy is used to help control symptoms of advanced bladder cancer. But it is not often likely to be the most useful treatment in this situation.

A cystectomy and urinary diversion may be done as an open operation or as keyhole surgery. Keyhole surgery is also called laparoscopic surgery. Your surgeon will talk to you about which type of surgery is likely to be best in your situation. Some types of surgery will not be available in all hospitals. You may need to be referred to another hospital to have it done.

An open cystectomy means the surgeon makes one cut in your lower tummy (abdomen) to do the operation.

Laparoscopic surgery means the surgeon makes several small cuts in the tummy. They pass a thin tube with a light and camera on the end called a laparoscope into the tummy through one of the cuts. They use surgical tools through the other cuts to remove the cancer.

Keyhole surgery may have less complications than open surgery, and wounds may heal faster. This may mean you recover more quickly.

Sometimes the surgeon uses a machine (robot) during keyhole surgery. This is called robotic-assisted surgery. The surgeon controls a robotic tool that holds the instruments. Your surgeon can explain more about the benefits and disadvantages of this type of surgery.

After the operation, you will be looked after in a high-dependency or intensive care unit for 1or 2 days.

The nurses will encourage you to start moving about as soon as possible after your operation. This helps to prevent problems such as chest infections or blood clots. They will encourage you to do regular leg movements and deep breathing exercises. A physiotherapist or nurse can explain these to you.

You may have loose or runny stools (poo) after your surgery. This is because part of the bowel is used to make a urinary diversion. It usually gets better over time. Tell your doctor or specialist nurse if it continues.

At first, you have fluids through a drip (infusion) into a vein in your hand or arm. You may be given painkillers through your drip. Once you are eating and drinking again, the drip is removed.

Some people may have a tube that goes up the nose and down into the stomach. This is called a nasogastric tube. It is used to remove fluid from the stomach, so you do not feel sick. This is usually removed 1 or 2 days after surgery.

You may have a tube close to the operation wound to drain fluid away. A nurse will take this out after a few days, when fluid stops draining.

You will have tubes to help drain urine (pee) from your body. The tubes you have depend on the type of urinary diversion you have. Your doctor and nurse will give you more information.

After your operation, you will need medicines to manage any pain for a few days.

To begin with, you may be given painkillers into a vein using an electronic pump. You control the pump using a hand control that you can press when you need more of the painkiller. This is called patient-controlled analgesia (PCA). It is fine to press the hand control whenever you have pain. The nurse sets the pump so you cannot have too much painkiller.

Some people are given painkillers into their back. This is called an epidural. The drugs numb the nerves in the area where you had the operation to control your pain. You usually have them through a drip (infusion) attached to an electronic pump.

Sometimes during the operation, the surgeon puts small tubes into the area around the wound. After the operation, your doctor or nurse uses these tubes to give you painkillers. This helps to numb the nerves in the same way as an epidural.

If you are in pain, tell your nurse or doctor straight away. You will be given painkillers to take before you go home.

The surgeon uses stitches or staples to close the wounds during surgery. They will explain when these need to come out and will arrange for a nurse to do this. Wound infections can be a complication of the surgery. Signs the wound is infected include:

• heat
• redness
• swelling
• fluid or pus coming from the wound
• feeling unwell
• a fever or high temperature.

Tell your nurse or doctor if you have any of these symptoms, even after you go home. If you are unable talk to your hospital team, tell your GP or out-of-hours service.