Choices for cystectomy surgery include:
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Open surgery. This approach uses a single cut, called an incision, on the belly to get to the pelvis and bladder.
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Minimally invasive surgery. With minimally invasive surgery, the surgeon makes several small cuts in the belly. The surgeon then puts in special surgical tools through the cuts to work on the bladder. This type of surgery also is called laparoscopic surgery.
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Robotic surgery. Robotic surgery is a type of minimally invasive surgery. The surgeon sits at a console and moves robotic surgical tools.
During the procedure
You're given a medicine, called general anesthesia, that keeps you asleep during surgery. Once you're asleep, your surgeon cuts into your belly. There's one large cut for open surgery or several smaller cuts for minimally invasive or robotic surgery.
Your surgeon removes the bladder from surrounding tissues. If the treatment is for bladder cancer, the surgeon also will remove nearby lymph nodes. The lymph nodes are part of the immune system. These will be looked at in a lab to see if cancer has spread to them.
A radical cystectomy includes removal of the prostate and seminal vesicles or removal of the uterus, ovaries, fallopian tubes and sometimes part of the vagina. How much of the urethra is kept depends on the type of urinary diversion the surgeon makes.
After your bladder is removed, your surgeon makes a new system for removing urine, called a urinary diversion. Choices include:
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Ileal conduit. The surgeon uses a piece of the small intestine to make a tube, called a conduit. The ureters, which were joined to the bladder, are then joined to the conduit.
Urine drains into the conduit and passes outside the body through a hole in the wall of the belly, called a stoma. The urine collects in a pouch worn under clothes. The pouch needs to be drained often and replaced regularly.
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Continent urinary reservoir. During this procedure, the surgeon uses a piece of the intestines to make a pouch, called a reservoir, inside the belly. Like the ileal conduit, the reservoir joins to ureters and a stoma in the belly wall. But the reservoir stores the urine. To drain it, you put a thin tube, called a catheter, into the stoma through a small opening in the belly.
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Neobladder reconstruction. The surgeon reshapes a part of the intestines into a pouch that serves as a bladder. The new bladder goes into the same place as the old bladder and joins to the ureters and urethra. The neobladder allows you to urinate as you did with your old bladder. You may need to put a catheter into your urethra to drain the new bladder all the way.
After the procedure
After general anesthesia, you may have side effects such as sore throat, shivering, sleepiness, dry mouth, nausea and vomiting. You may get medicines to ease symptoms.
Starting the morning after surgery, your healthcare team may have you get up and walk often. Walking promotes healing and helps the bowel work again. It also improves blood flow and helps prevent joint stiffness and blood clots.
The slow return of the bowel working often delays recovery after a radical cystectomy. If you have an open procedure, you'll likely be in the hospital for 5 to 7 days. With a minimally invasive procedure, your time in the hospital may be shorter.
Before you leave the hospital, a nurse or other healthcare professional gives you written instructions about wound care and guidelines for when to call your care team or get urgent care. Depending on the type of urinary diversion you had, you'll also get instructions about care, cleaning and use of devices.
Follow-up appointments
You return to the clinic for follow-up care in the first few weeks after the cystectomy and again after a few months. At these appointments, your healthcare team will check to make sure that your upper urinary tract drains well and that the water and sodium, called electrolytes, in your body are balanced.
After bladder removal surgery, you have follow-up appointments for the rest of your life. These are to check that the neobladder or other urinary diversion is working right. If you have a cystectomy to treat bladder cancer, you have regular follow-up visits to check for cancer returning.
Return to activities
During the first six weeks or so after surgery, you may need to restrict activities such as lifting, driving, bathing, and going back to work or school. You should be able to shower soon after surgery.