Surgery for bladder cancer
There are many kinds of surgery for bladder cancer. Some involve removing the whole bladder and others do not. The type of surgery depends on the stage of the cancer. The most common types of surgery are explained below.
This operation is used for many early stage bladder cancers. 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 (abdomen). 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 treatment 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 right 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, long-term side effects may become a problem. 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 part of the bladder is removed (along with part of the bladder wall), it is called a partial cystectomy. This surgery allows the person to keep part of the bladder, but they might have to go more often, and the cancer might come back in a different part of the bladder.
If the whole bladder is removed it 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 surgeries are usually done through a cut 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.
For either operation, you will be given drugs to put you into a deep sleep. It is important that the surgeon doing this operation have experience in treating bladder cancer. If the surgery is not done well, the cancer is more likely to come back.
Reconstructive surgery: If the whole bladder is removed, you will need another way to store and remove urine. There are several ways to do this. These options can have a strong impact on how you feel about your body. You should talk to your doctors and nurses about any worries or concerns you might have when making these decisions.
One option is an ileal conduit. To do this, a short piece of the small intestine (bowel) is removed and used to connect the ureters to the skin of your belly though a small opening (called a urostomy or a stoma). A small bag is placed over the stoma to catch the urine. The bag needs to be emptied once it is full.
A second method is called a continent diversion. This does not require a bag outside the body. Instead, the surgeon creates a sac from a small piece of intestine and attaches the ureters to it. Urine is emptied when a drainage tube (catheter) is put into the hole (stoma) of the diversion.
Newer methods of surgery can route the urine back into the urethra by creating a new bladder (called a neobladder) out of a piece of intestine. This lets the patient urinate normally.
Possible side effects of surgery
Cystectomy is a major operation, and the complications and side effects can be serious. Short-term side effects of cystectomy could include problems from anesthesia, a lot of 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 wound 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. Sperm cells are still made but they are reabsorbed into the body.
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 half of the vagina, which can make sex less comfortable for some women. Orgasms and lubrication may also be affected. You will want to talk with your doctor to learn how surgery is likely to affect your sex life. 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. During a cystectomy, the 2 nerve bundles that run along each side of the vagina can be damaged when the front of the vagina is removed. Women who have surgery that preserves these nerve bundles may have better sexual function after surgery than those whose nerve bundles are removed or cut. Talk with your doctor about whether these nerves can be left in place.
Another problem that can happen during radical cystectomy is that the doctor takes out the end of the urethra where it opens outside the body. This can make the clitoris lose a good deal of its blood supply and may affect some parts of sexual arousal. Talk with your doctor about whether the end of the urethra can be spared, and how that may affect your chances of normal clitoris function.
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.
Last Medical Review: 12/03/2012
Last Revised: 01/21/2013