Bladder removal surgery / cystectomy
For men: your surgeon will remove the bladder, prostate, and seminal vesicles. We may be able to operate using a prostate or nerve-sparing technique. The lymph nodes near the bladder will be removed as well.
For women: your surgeon will remove the bladder, uterus, ovaries, and part of the vaginal wall. If possible, we will spare the uterus or ovaries. The lymph nodes near the bladder will be removed as well.
Before your surgery, we will decide on a way to drain the urine from the kidneys in the future. In most cases, we can use a part of the small intestine to create a urinary ostomy bag on the right side of the lower abdomen, connected to the ureters (the tubes leading out of the kidneys). This is called a “Bricker” and is the most common solution to drain the urine after a cystectomy. We have listed several other options below. We will help you choose the option that best fits you at the clinic.
Surgery can be laparoscopic (keyhole surgery) using the Da Vinci robot, or laparotomic (open abdominal surgery). The type of procedure most suitable for you will depend on several factors. Your physician will discuss your options with you.
Before and after your surgery
Your clinical nurse specialist will inform you about the surgery, admission complications, and follow-up care.
Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.
Wound and ostomy nurse
Your wound and ostomy nurse will show you several urostomy materials while explaining the many possibilities and life with a urostomy. if you are getting a neobladder, your nurse will show you how you should empty the bladder using a catheter. On the day of your surgery, we will draw a dot on your stomach to indicate the best spot for a potential urostomy. We will take your body shape and clothes into consideration. After surgery, your nurse will show you how to look after your urostomy or neobladder.
How to urinate?
There are various ways in which you can make sure that your urine leaves the body through the ureters after bladder removal. We will discuss your options with you. Below is a short overview of the various possibilities:
To create a urostomy, your surgeon will use a part of the end of the small intestine through which the urine leaves the body. Because the resulting flow will be continuous, you will need to attach a small bag to collect the urine. You will never have to worry about visiting the bathroom. Once the bag is full you can easily empty it in the toilet. You won't need to set an alarm at night to empty the urostomy. One downside is that this method will change the appearance of your stomach.
Your surgeon will use a section of the end of the small intestine to create a pouch, which will be attached to the urethra. This won't cause any visible changes to your body.
By pressing down on the abdomen and using your abdominal muscles, you can empty the neobladder. Your urine will leave the body through the urethra. One downside is that the urine may not come out as easily, requiring a catheter, or our sphincter may not be strong enough to hold in the urine, which can lead to incontinence. You won't feel the urge to urinate and will have to make sure that you can go to the bathroom at specific times, including at night. You will also be at a higher risk of urinary tract infections than people with a urostomy.
Your surgeon will use a part of the end of the small intestine and the start of the large intestine to create a pouch. Unlike a neobladder, this pouch is not connected to the urethra but instead leads to a catheter that leaves the body through the abdominal wall, usually near the belly button.
The pouch will need to be emptied every couple of hours with the help of a catheter. You will not be able to urinate yourself. The pouch rarely leaks, so you won't need a bag to collect the urine and can close it off using a bandaid instead. You may experience problems with the insertion of the catheter, or fully emptying the pouch, which can cause urinary tract infections. After several years, the pouch may start leaking, requiring a patch made out of a bit of your skin. Your abdomen will have a different appearance due to the opening for the catheter and the bandaid.
This is a rare approach only used with patients who also need to have part of their rectum removed and who also need a colostomy. We can opt to use a part of the large intestine instead of the small intestine to craft a urostomy. The pros and cons of this are comparable to the Bricker, although patients receiving a colonic conduit won't need to have a connection in the colon made during surgery.
Patients who will only have one kidney left after surgery may need a type of ostomy that leads the ureter directly outside of the skin without a pouch made out of the intestine. The urine will flow directly into the bag attached to the abdomen. The main benefit is that you won't need to undergo intestinal surgery, which will speed up your recovery. You may experience scarring near the opening, which can clog the drain. Patients with a ureterocutaneostomy will need to have a tube running from the kidney to the skin to keep the drain open and accessible. This is called a single J and will need to be replaced regularly at the clinic.
You can find more information in Dutch on www.stomaofneoblaas.nl.
Explanation of bladder removal surgery
The day of your surgery
The day itself
- You will be admitted to the hospital one day before your surgery for preparations.
- Your ostomy nurse will visit you to decide on the best spot for your urostomy and will draw a dot on your stomach.
- You will be wheeled to the surgery department in your bed.
- From there, you are taken to the operating room.
- Your urologist and anesthesiologist will run one final check together with their team of surgical assistants and anesthesiology assistants. They will ask you several questions.
- Then your surgery will start. It will take about 6 hours.
- After surgery you will be taken to the recovery room or intensive care, depending on what you were told before your surgery.
What to expect during admission?
- As of the day after your surgery, please try and get out of bed and move around as soon as possible.
- You can eat or drink directly after surgery.
- Most people spend a week at the hospital after surgery on average.
Leaving the hospital
- You will learn how to navigate your new situation at the hospital.
- You may receive extra help at home.
- After a few days we will call you to ask how you are doing, and to schedule check-up appointments for you.
Side effects and complications
- The exact side effects you will experience depend on the type of bladder reconstruction you get. This will be discussed with you at the clinic before your surgery. Most people will experience fatigue, building activities slowly decreased focus, and working through the emotions of the experience.
- Sexual dysfunction is a common side effect in both men and women. Men may experience erectile dysfunction and loss of ejaculation. Women may experience vaginal dryness and pain during sex. We have set up a special clinic for cancer and sexuality in the urology department.
Recovery at home
- It may take some time before you are recovered and in good shape. You cannot exert yourself for 6 weeks after your surgery. Please do not bike, do heavy lifting, or intense work around the house during these 6 weeks. Your recovery will take 3 months on average. If you had been treated with chemotherapy before your surgery, your recovery may take longer. You may feel fatigued for months after surgery.
- Patients will be invited to come to the hospital for regular checkups by our urologists and clinical nurse specialists. We check whether everything went well after your surgery, and whether your tumor came back. Your wound, continence, and ostomy nurse will keep in touch with you about your neobladder or urostomy.
- During the first year, you will have to come to the NKI for your checkups. Most people can return to their referring hospital after one year.