Cystectomy in Women

What is a cystectomy?

There are 2 types of cystectomy procedures: simple and radical. In a simple cystectomy the surgeon removes only the bladder. In a radical cystectomy the surgeon removes the bladder and surrounding lymph nodes and all of the genital organs (the uterus, tubes, ovaries, and part of the vagina).

There are many ways for the surgeon to then create a new way for urine to leave your body. Ask your healthcare provider what procedures you will be having.

When is it used?

The reasons for removing your bladder include:

• You may have cancer in the bladder (which usually requires a radical cystectomy).
• The bladder may be damaged from radiation treatment.
• The bladder may be bleeding from chemotherapy.
• The bladder may be damaged or may be bleeding uncontrollably from other causes or treatments.
• The bladder may not be working well because of nerve or muscle damage from a nerve disease or spinal cord injury.

Examples of alternatives to this surgery are:

• having radiation therapy, chemotherapy, photodynamic therapy, or other forms of cancer treatment if you have cancer
• choosing not to have treatment while recognizing the risks of your condition.

You should ask your healthcare provider about these choices.

How do I prepare for a cystectomy?

Make sure that you talk to your healthcare provider about the procedure, its effects on you, and the likely outcome. Find someone to drive you home after the surgery. Plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Your provider will give you laxatives and antibiotic pills to cleanse your bowels. Do not eat anything the night before the procedure, and drink only clear liquids. After midnight and the morning before the procedure, do not eat or drink anything. Do not even drink coffee, tea, or water.

Follow any other instructions your provider gives you.

What happens during the procedure?

You will be given a general anesthetic before the procedure. A general anesthetic will relax your muscles and put you to sleep. It will keep you from feeling pain during the operation.

The surgeon will make a cut (incision) in your abdomen to expose the bladder and tie off the blood supply to it. Then he or she will remove the bladder (a simple cystectomy).

If you are having a radical cystectomy, the surgeon will also remove the lymph nodes in the area. In most cases the uterus, ovaries, fallopian tubes, and part of the vagina will also be removed.

The surgeon will make a new passageway for urine through an opening in your belly. The new passageway with the opening in the belly is called a urostomy. The surgeon makes the urostomy by cutting the ureters at the place where they enter the bladder. (The ureters are the tubes that normally drain urine from the kidneys into the bladder.) The surgeon cuts out a piece of the small bowel. The ureters are connected to the piece of bowel. One end of the piece of bowel is brought to an opening made in the skin of your belly. Urine can drain from the kidneys and out of your body through this new passageway. An ostomy bag attached to the opening in your skin will collect the urine. This is called a standard urostomy.

In some cases, the surgeon may be able to make a new bladder inside your body out of a piece of your bowel. This new bladder can collect urine. It may be connected to the urethra so that a urostomy and bag will not be needed to drain urine. Or the new bladder may be connected to a hole in your belly and urine will be drained from it with a small flexible tube called a catheter. This is a type of urostomy called a continent urostomy.

What happens after the procedure?

• You may be in the hospital for 4 to 12 days, depending on your condition. You may be in an intensive care unit for the first 2 or 3 days.
• You may have a tube that passes through your nose into the stomach.
• The cut in your abdomen may drain for a few days.
• If you have a urostomy, you will have a bag on your side to collect urine as it flows out of the new passage. If you have a new bladder, you will have a catheter for 2 to 3 weeks.
• You will need to learn how to drain or dispose of your urine.
• You should avoid strenuous activity for the next 6 to 8 weeks.

Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

• You will no longer have the problems caused by a bladder that is diseased or doesn’t work well.
• If there was cancer in the bladder, the cancer may be removed.

What are the risks associated with this procedure?

Though many women do well during the procedure and live comfortably thereafter, there are risks:

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• The nerves and blood vessels around the bladder could be cut or damaged.
• You may lose feeling in the groin area.
• Fluid may leak from the area where lymph nodes were removed and collect in the abdominal cavity.
• Your rectum might be cut and need surgical repair.
• Your bowel could leak where the section of it was removed, or it could become narrowed and require surgery.
• Urine could leak out where the ureters are joined to the section of bowel.
• The ureters could become blocked and keep urine from flowing out of your body.
• The skin around the area where the bowel is sewn to the skin could become infected.
• The cut in the abdomen may not heal well and may become infected.
• You may have bleeding.
• If you had cancer, the operation may not remove all of it. The cancer may grow back.
• If a lot of the vagina is removed as part of the procedure, it may be harder or more painful to have sexual intercourse.
• You may have problems with urine control, especially if a new bladder was made and connected to your urethra or a hole in your belly.
• Your bowel function may change. You may have frequent bowel movements or diarrhea.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have trouble passing urine.
• You have a fever.
• You have nausea or vomiting.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.