What is Radical Cystectomy

Radical cystectomy is a surgical procedure to remove the bladder. The bladder is the organ in the lower belly that holds urine until it is passed out of the body (urination).

You may have a radical cystectomy if you have bladder cancer that has spread into your bladder muscle or to more than one spot in your bladder. Bladder cancer cells can also spread to lymph nodes and other organs that are near your bladder. You may need to have lymph nodes or other organs removed during a radical cystectomy. These may include:

• The prostate gland and the glands that make semen (seminal vesicles) in men.
• A small part of the vagina and reproductive organs, such as the ovaries, fallopian tubes, and uterus, in women.

This procedure also includes a type of reconstructive surgery that allows you to urinate without a bladder (urinary diversion).

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have, including the possibility of pregnancy.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Injury to other organs, especially the last part of your large intestine (rectum).
• Blockage in your intestine (bowel obstruction). This can lead to complications, including infection.
• Blood clots that can break off and travel to other parts of the body.
• Leaking of urine or obstruction of urine flow.
• Pelvic nerve damage.
• Sexual problems. Men may have trouble keeping an erection (erectile dysfunction). Women may lose the ability to have an orgasm.
• Cancer recurrence, if the procedure does not get rid of all of the cancer.

What happens before the procedure?

• Ask your health care provider if you should donate some of your own blood before surgery in case you need to receive blood (transfusion) during the procedure.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Do not drink alcohol or smoke cigarettes before your procedure as told by your health care provider.
• You will need to clean out your bowels before surgery (bowel prep). Follow instructions from your health care provider about how and when to do this.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to make you fall asleep (general anesthetic).
• You may have a tube passed through your nose and into your stomach (NG tube).
• You may also have a narrow tube (catheter) inserted into your bladder to drain urine during and after surgery.
• Your surgeon will make an incision into your belly and down through the muscles to locate your bladder.
• The tissues and organs that are attached to your bladder will be cut. These include:
  • The two tubes that connect your kidneys to your bladder (ureters).
  • The tube that leads out of your body from your bladder (urethra).
  • Blood vessels.
• Men may also have the prostate gland and seminal vesicles removed.
• Women may also have the uterus, fallopian tubes, ovaries, and upper part of the vagina removed.
• Lymph nodes that are near your bladder will be removed.
• Your surgeon will do the type of urinary diversion that is best for you. You may have:
  • An incontinent diversion. In this procedure, a short piece of intestine will be removed and connected to the ureters. This will create a tunnel directly out of your body (ileal conduit). Then, one end of the conduit will be pulled through your belly wall and attached to the outside of your skin. This will make an opening (stoma) to drain urine.
  • A continent diversion. In this procedure, a pouch to collect urine will be made from part of your intestine. Your ureters will be connected to one end of the pouch. There will be a valve in the other end. This end will be pulled through your belly wall and attached to the outside of your skin. You will drain urine several times a day using a tube (catheter) that is passed through the stoma.
  • A neobladder. This procedure will make a new bladder from part of your intestine. Your ureters will be attached to the new bladder. The neobladder will be sewn to your urethra. This will allow urine to flow through your urethra like it did before surgery.
• After making the urinary diversion, your health care provider will close your belly incision with stitches (sutures) or staples.
• A bandage (dressing) will be placed over your incision.
• If you have a stoma, a bag may be placed over it to collect urine (urostomy bag).
• If you have a neobladder, a catheter will be placed through your urethra to drain urine from your new bladder.
• You may have a small plastic tube (surgical drain) placed so that fluid can drain away from the surgery site while it heals.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given pain medicine as needed. You may also get antibiotics and fluids through your IV tube.
• You will be urged to get up and walk around as soon as you can.
• Your IV tube and NG tube can be taken out after you can eat and drink on your own.
• If you have a neobladder, you may be sent home with a catheter. Your health care provider will give you instructions for caring for your catheter at home.
• You will be shown how to care for the type of urinary diversion that you have. Make sure that you understand these instructions. Follow them carefully.
• You may be sent home with a surgical drain. Your health care provider will give you instructions for caring for your drain at home.

Radical Cystectomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain or belly soreness.
• Leakage of urine or difficulty urinating.

Follow these instructions at home:

Activity

• Do not douche or have sex until your health care provider says you can.
• Do not do exercises that put pressure on your abdominal muscles. These include sit-ups and weight lifting.
• Rest as told by your health care provider.

Incision care

• There are many ways to close and cover an incision. For example, an incision can be closed with stitches (sutures), skin glue, or adhesive strips. Follow instructions from your health care provider about:
  • How to take care of your incision.
  • When and how you should change your bandage (dressing).
  • When you should remove your dressing.
  • Removing whatever was used to close your incision.
• Check your incision area every day for signs of infection. Watch for:
  • Redness, swelling, or pain.
  • Fluid, blood, or pus.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.
• Depending on the type of urinary diversion that you have, follow directions from your health care provider or ostomy care nurse.
• Care for your catheter as told by your health care provider, if this applies.
• Care for your surgical drain as told by your health care provider, if this applies.
• Drink fluids to help flush your urine as told by your health care provider.
• Do not take baths, swim, or use a hot tub until your health care provider says you can.

Contact a health care provider if:

• You have redness, swelling, or pain at the site of your incision or stoma.
• Your urine becomes cloudy or dark, or it smells bad.
• You have chills or a fever.

Get help right away if:

• You have fluid, blood, or pus coming from your incision or stoma.
• Your sutures break open.
• The edges of your incision break open after the sutures have been removed.
• You have bright red blood or blood clots in your urine.
• You cannot urinate through your urethra or stoma.
• You have trouble breathing.
• You have new abdominal pain and you also have:
  • Nausea.
  • Vomiting.
  • Bloating.
  • Trouble passing gas or stool.