Cystectomy

A cystectomy is surgery to remove part or all of the bladder. It is mainly used to treat bladder cancer.

There are three types of surgery.

• 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. That's the tube that carries urine from your bladder and out of your body. Nearby organs that may have cancer cells are removed as well. This may include the prostate and seminal vesicles in men. And it may include the uterus and ovaries in women.

A cystectomy is mainly used to remove and try to cure cancer that has invaded the wall of the bladder or has come back (recurred) after treatment or that has a high chance of spreading.

The surgery is done through a cut (incision) the doctor makes in your lower belly. Sometimes it can be done as laparoscopic surgery. This type of surgery needs only small cuts. To do it, a doctor puts a lighted tube, or scope, and other tools through small cuts in your lower belly. The doctor can see your organs with the scope.

If you have a simple cystectomy or radical cystectomy, your doctor will create a new way for you to pass urine. There are a few ways this can be done.

• An ileal conduit uses a piece of your small intestine to make a tube. The doctor connects one end of the tube to an opening he or she makes in your belly. The other end of the tube attaches to your ureters. Those are the two tubes that carry urine from the kidneys to the bladder. After surgery, the urine will pass from the ureters through the tube. Then it goes out the opening into a plastic bag. The bag is attached to your skin.
• A continent reservoir uses a piece of your bowel to make a storage pouch. It is attached inside your pelvis. There are two types of storage pouches. Both types let you control when you pass urine. You may have a:
  • Bladder substitution reservoir. (This may be called a neobladder.) If your urethra was not removed, the storage pouch will attach to your ureters at one end and to your urethra at the other. This lets you pass urine much like you did before surgery.
  • Continent diversion reservoir with stoma. (This may be called a urostomy.) If all or part of your urethra was removed, the storage pouch will connect your ureters to an opening the doctor makes in your belly. You will put a thin plastic tube called a catheter through the opening to let out the urine.

For bladder cancer that has spread to the muscle layer, radical cystectomy is the best treatment for preventing the spread or recurrence of cancer and helping people live longer.