Cystectomy: Everything You Need to Know

A cystectomy is a surgical procedure that is done to remove the bladder, usually due to cancer. The bladder is a pouch which is located in the pelvis. It holds urine made by the kidneys until it is full and needs to be emptied.

This article will review the ways a cystectomy is completed, as well as how to prepare and the potential risks associated with this surgery.

What Is a Cystectomy?

If bladder cancer is invasive, either part or all of the bladder may need to be removed. This procedure is called a cystectomy.

In a partial cystectomy, only part of the bladder wall is removed, and the bladder is closed with sutures. Nearby lymph nodes are removed, often along with the prostate in men. In women, often the ovaries, fallopian tubes, uterus, cervix, are removed as well.

When the bladder is completely removed (called a radical cystectomy), a new way for urine to pass out of the body will need to be constructed. This can be done in multiple ways, including:

• Ileal conduit: In this procedure, a new passageway that allows urine to drain to a bag outside of the body is created. To do this, a surgeon will remove a piece of intestine and attach it to the ureters (the duct through which urine passes from the kidney to the bladder). Then the intestine tube is connected to an opening in the surface of the skin (called a stoma), and a bag to catch urine as it drains out is placed on the outside of the opening on the stomach. 
• Neobladder: In this procedure, a new bladder is made using part of the intestine. It is then attached to the ureters, so urine can drain from the kidneys and into the neobladder. The urethra is attached to the neobladder, and urine leaves the body through the urethra.

Both partial and total cystectomy typically require an inpatient stay in the hospital, usually for about one week.

Contraindications

This surgical procedure can be performed on both adults and children, if needed. Though there are no specific contraindications to surgery (reasons not to perform surgery), there may be some factors present that help the surgeon determine which type of cystectomy can or cannot be done. Some of these factors can include:

• Inflammatory bowel disease
• Kidney failure
• Liver failure
• Strictures in the urethra or ureters
• Stage of bladder cancer

Potential Risks

The potential risks associated with a cystectomy can include:

• Bleeding
• Development of blood clots
• Infection
• Injury to organs near the bladder

Purpose of Cystectomy

A cystectomy is one of the treatments that may be needed for bladder cancer. 

When cancer invades the muscle wall of the bladder, a cystectomy may be required. Sometimes chemotherapy medications (cancer-fighting drugs) are given first to help shrink the tumor and make the surgery more successful. 

As part of the diagnosis and staging process of bladder cancer, often many tests and imaging studies need to be done. These tests can include:

• Computed tomography scan (CT scan): Imaging test that compiles multiple X-ray images to create a 3D look at an organ
• Positron-emission tomography (PET) scan: Imaging test that evaluates how tissues and organs are functioning on the cellular level
• Cystoscopy: Procedure in which a thin tube (cystoscope) with a camera on the end is thread through the urethra and used to look inside the bladder
• Blood work, such as complete blood count (CBC) or comprehensive metabolic panel (CMP)

How to Prepare

Any questions you may have as you prepare for a cystectomy should be addressed by your surgeon or their healthcare team.

Location

A cystectomy is done in a hospital operating room, and an inpatient stay of about one week is required following surgery. 

What to Wear

Comfortable clothes should be worn to the hospital, and you will be asked to change into a hospital gown prior to surgery. 

Food and Drink

Typically, no eating or drinking is allowed starting at midnight the night before surgery.

Medications

It is important that the surgeon and anesthesiologist, the doctor who will administer the medication during surgery, are aware of any medications you take. Some may need to be taken the day of surgery, with a sip of water. Other medications, especially blood thinners, may need to be held off for a few days before surgery. Be sure to follow your healthcare provider's instructions leading up to surgery.

What to Bring

Bring a bag with comfortable clothes, as well as toiletries, reading material, and other necessities that may make you feel more comfortable following surgery. 

The hospital will tell you anything else that you need to bring, including an identification card or insurance card. 

Do not bring any valuables, such as jewelry or cash, with you to the hospital. 

Pre-Op Lifestyle Changes

If you smoke, quitting smoking before surgery can be important for recovery. Quitting smoking can reduce the risk of complications during and after surgery and can help the body heal better after surgery.

What to Expect on Day of Surgery

Before the Surgery

On the day of surgery, arrive at the time that the surgical team appoints you. When you arrive at the hospital, register at the appropriate location. The operating room staff will direct you to a pre-operative room, where you will change into a hospital gown.

An IV (intravenous) cannula may be placed into your arm, which will allow medications to be administered during the surgery.

During the Surgery

When the surgeon is ready, you will be taken into the operating room. Once you are positioned properly on the operating table, the operating room staff will place heart monitoring leads on your chest, as well as a blood pressure cuff on your arm. This will allow vital signs to be monitored during surgery. 

The anesthesiologist will administer medication to help you relax and put you to sleep. A tube will be placed into your lungs to assist with breathing during the surgery.

Next, the surgical team will clean and prepare the site of surgery, and place sterile surgical drapes over your body. 

The full preparation and surgical steps will depend upon the exact type of cystectomy being completed.

After the Surgery

After surgery, you will be moved to a post-operative recovery room, where you will continue to be observed following surgery as you are waking up. After you are sufficiently awake, you will be transferred to your hospital room.

Vital signs and inspection of the surgical area for any signs of bleeding or infection will continue after surgery. 

A typical hospital stay following a cystectomy is usually five to seven days.

Recovery

A cystectomy is major surgery, and recovery can take some time. Be sure to follow all instructions as provided by your surgeon to help speed recovery and healing. 

Healing 

The skin where the incisions were made may be discolored or bruised due to bleeding during the procedure. Inspect the surgical incisions frequently to make sure there are no signs of infection. These signs can include:

• Redness around the incision
• Yellow drainage or pus from the incision
• Warmth of the skin around the incision
• Swelling at the surgical site
• Fever or chills

Coping with Recovery

Recovery from a cystectomy can take some time, especially if a radical cystectomy was done. Full recovery from this surgery may take months. 

Recovery from a partial cystectomy may not take as long.

Long-Term Care

Having a cystectomy may result in permanent changes to how you are able to urinate and can take some time to adjust to. 

Discuss any concerns or problems with your surgeon or healthcare team if they arise, and don't hesitate to ask any questions along your journey.

Lifestyle Adjustments

Lifestyle changes may be necessary following a cystectomy, especially if you have a change in how your body empties urine.

If you have a bag attached to your abdomen for urine to drain, you may require different clothing to avoid anything too tight around the abdomen. 

Having a neobladder may result in the need to use a catheter to drain urine. This can require time to learn how to do it properly, and until then you may not feel as comfortable performing this procedure outside of the home.

A Word from Verywell

Being told you need to have a cystectomy can be worrisome. Preparing for the type of surgery that you need and having a plan for post-operative recovery can be very helpful in making the surgery and recovery successful.

Be sure to follow all the instructions given to you by the surgical team. If you have any questions, ask them. Being prepared and ready is a very important part of the surgical plan.