Surgery for bladder cancer
Surgery is part of the treatment for most bladder cancers. The type of surgery depends on the stage of the cancer.
For many early stage bladder cancers, a transurethral resection (TUR), also known as a transurethral resection of the bladder tumor (TURBT), is the most common treatment. Most people have early-stage cancer when it is first found, so this is usually the first treatment they get.
Tumors in the bladder are removed using a slender tube with a lens and a light on the end that is put into the bladder through the urethra. This tube is called a resectoscope. You will be in a deep sleep (under general anesthesia) or the lower part of your body will be numbed (regional anesthesia) for this. There is no need to cut into the belly.
After surgery, other things may be done to get rid of any remaining cancer. These could include burning the base of the tumor through a cystoscope or treating it with a laser.
The side effects of this surgery are often mild and do not usually last long. You might have some bleeding or mild pain when you urinate after surgery. You can usually go home the same day or the next day. In less than 2 weeks you should be able to go back to your normal activities.
This treatment usually works well, but bladder cancer still often returns in other parts of the bladder. If this surgery has to be done several times, there is a chance that the bladder can become scarred and not able to hold much urine. This means having to urinate often and the chance of losing control of your urine (incontinence).
In patients whose non-invasive, low-grade tumors tend to come back, the surgeon may sometimes just burn small tumors that are seen during cystoscopy (rather than taking them out). This can often be done using numbing medicine in the doctor’s office. It is safe but can be somewhat uncomfortable.
When bladder cancer is invasive (the cancer has spread beyond the layer of cells where it started and deeper into the bladder wall), all or part of the bladder may need to be removed. This operation is called a cystectomy.
When only the tumor and part of the bladder is removed, it is called a partial cystectomy. Nearby lymph nodes are also removed. This surgery allows the person to keep part of their bladder, but it will be smaller so they might have to go more often. The cancer might also come back in a different part of the bladder.
Surgery to remove the whole bladder is called a radical cystectomy. Nearby lymph nodes are also taken out. In men, the prostate is removed as well. In women, the womb (uterus), ovaries, fallopian tubes, and a small part of the vagina are often removed.
These procedures are usually done through a cut (incision) in the belly (abdomen) to get to the bladder. In some cases, the surgery may be done through several smaller cuts using special long, thin instruments, one of which has a tiny video camera on the end. This is known as laparoscopic, or “keyhole” surgery. This type of surgery may result in less pain and a quicker recovery because of the smaller cuts. But it has not been around as long as the standard type of surgery, so it’s not yet clear if it works as well. For either operation, you will be given drugs to put you into a deep sleep.
It is important that the surgeon doing any type of cystectomy be experienced in treating bladder cancer. If the surgery is not done well, the cancer is more likely to come back.
Reconstructive surgery after cystectomy
If the whole bladder is removed, you will need another way to store and remove urine. There are several ways to do this.
Incontinent diversion: To do this, a short piece of the small intestine (bowel) is removed and used to connect the ureters to a small opening (called a urostomy or a stoma) in the skin of your belly. This is known as an ileal conduit. A small bag is placed over the stoma to catch the urine. The bag will need to be emptied when it fills up. This approach is called an incontinent diversion because you no longer control the flow of urine out of the body.
Continent diversion: This method does not require a bag outside the body. Instead, the surgeon creates a sac from a piece of intestine. One end is attached to the ureters, and the other end has a small valve where it is attached to a small hole (stoma) in the skin over your belly. Urine is stored in the pouch. You then empty the pouch several times a day by putting a drainage tube (catheter) into the hole (stoma) of the diversion and through the valve.
Neobladder: A newer method of surgery can route the urine back into the urethra by creating a new bladder (called a neobladder) out of a piece of intestine. The neobladder is sewn to the urethra, which lets the patient urinate normally. Over time, most people will be able to urinate normally during the day, but many people might still have some incontinence at night.
Possible side effects of surgery
Cystectomy is a major operation, and the side effects can be serious. Immediate risks include problems from anesthesia, bleeding, blood clots, and infections. Most people will have some pain, which most often is helped by pain medicines.
Aside from changing how urine leaves the body, problems from having a urostomy could include infections, urine leaks (incontinence), pouch stones, and blocked urine flow. There can be an emotional impact as well. You can find more information in our document Urostomy: A Guide.
Sexual effects in men: After radical bladder surgery, a man no longer makes semen. So the orgasm will be “dry”– that is, there will not be any semen.
Many men have nerve damage that makes them unable to have an erection. Newer types of surgery may lower the chances of this problem, and sometimes the problem improves over time. As a rule, the younger a man is, the more likely he is to be able to have full erections. This is something men should talk to their doctors about before surgery.
To find out more about dealing with sexual issues, please see our document Sexuality for the Man With Cancer.
Sexual effects in women: A radical cystectomy often removes the front part of the vagina. This can make sex less comfortable for some women, but most of the time intercourse is still possible. One option is to have the vagina rebuilt. This is known as vaginal reconstruction. There is more than one way to do this, so talk with your doctor about the pros and cons of each.
Radical cystectomy can also affect a woman’s ability to have an orgasm if the nerve bundles that run along each side of the vagina are damaged. Talk with your doctor about whether these nerves can be left in place.
If the doctor takes out the end of the urethra where it opens outside the body, the clitoris can lose some of its blood supply, which might affect sexual arousal. Talk with your doctor about whether the end of the urethra can be spared.
To learn more about ways to cope with these and other sexual issues, see our document Sexuality for the Woman With Cancer.
Sexual effects of urostomy: For both men and women, it is normal to be concerned about your sex life with a urostomy. Having your ostomy pouch fit right and emptying it before sex lowers the chances of a major leak. A pouch cover or small ostomy pouch can be worn with a sash to keep the pouch out of the way. Wearing a snug fitting shirt may work even better. To reduce rubbing against the pouch, choose positions for sex that keep your partner’s weight off of it. For more on this, see our document Urostomy: A Guide.
For more about surgery as a treatment for cancer, see our document Understanding Cancer Surgery: A Guide for Patients and Families.
Last Medical Review: 06/23/2014
Last Revised: 06/26/2014