When should one's bladder be removed?

In one of our latest articles here, Dr Ashwin Sridhar, a revered consultant urologist, explains when one’s bladder should be removed, before detailing bladder removal surgery, including side effects and recovery time. 

When should one's bladder be removed?

Bladder removal surgery, also known as cystectomy, is the removal of the urinary bladder. You might need removal of the bladder if a bladder tumour invades the muscle wall or if CIS or a T1 tumour still persists after BCG therapy. There are two types of cystectomy: simple cystectomy and radical cystectomy.

Simple cystectomy involves removing the bladder but not any of the surrounding structures, and it is used to treat benign bladder conditions such as neurogenic bladder, radiation cystitis, urinary fistula, and severe interstitial cystitis. Radical cystectomy, meanwhile, is surgery to remove the bladder to prevent further cancer spread.

It may also involve removing lymph nodes and some, or all, of the urethra. In men, radical cystectomy typically includes removal of the prostate and seminal vesicles, while in women, it usually includes removal of the uterus, ovaries, fallopian tubes, and part of the vagina. 

After removing the bladder, a surgeon needs to create a new way to store urine and have it leave the body. This is called urinary diversion. The surgeon will discuss the options for urinary diversion that may be appropriate for you. The medical team will not release the individual from the hospital until they are sure that the new urine evacuation system functions correctly. 

In some cases, people will have to undertake new steps to evacuate urine after they have had their bladder removed. When this occurs, hospital staff will teach both the person and their caregiver how to. Recovery time depends on the type of cystectomy you have. A complete recovery may take several weeks to months.

How is one’s bladder removed?

A bladder removal normally involves either an open-cut surgery or a laparoscopic or robotic-assisted surgery. When done for cancer, it is accompanied with the removal of bits of tissue called lymph nodes. 

These act as filters and lie near blood vessels. The filters catch cells from the fluid coming out of tissues and if the filters have cancer cells, it suggests the cancer has progressed. In men, it might need to be combined with removal of a part or the whole of the prostate, and in women, if the cancer is not confined just to the bladder, it might be combined with the removal of the uterus, cervix, and part of the vagina. 

Is it a potentially dangerous procedure?

The risks associated with cystectomy include bleeding, blood clots in the legs, and blood clots that travel to the lungs or heart. Additionally, there is a significant risk of complications and potentially even death (in up to three in every 100 patients within 90 days of surgery).

However, it is important to note that cystectomy is often necessary for treating bladder cancer and can improve survival rates. The five-year survival rate after cystectomy is about 65 percent.

What are the most reported side effects?

Bladder removal surgery, or cystectomy, is a major operation that involves the removal of the bladder. The risks and complications associated with bladder removal surgery include:

• Pain and discomfort after surgery 
• Adjustment to a new way of passing urine from the body 
• Changes in bathroom routines 
• Need for a new pathway for urine to leave the body
• Urinary incontinence or leakage (if we create a neobladder)
• Need for a catheter to empty the neobladder
• Longer hospital stay, typically between 5 and 14 nights
• Risk of infection 
• Risk of bleeding 
• Risk of damage to surrounding organs and tissues 
• Risk of blood clots 

It is important to prepare fully before going into bladder removal surgery, including understanding how life will be different afterward. Preparation can help set reasonable expectations for post-surgery life. 

What is recovery time like?

After a laparoscopic or robotic cystectomy, you'll typically need to stay in the hospital for at least four to five days. Many people can return to work or their usual activities four to six weeks after surgery, but you will probably need six to eight weeks to fully recover from the surgery. A complete recovery may take several weeks to months.

Bladder surgery can have long-term effects on urinary function. These may include:

• Difficulty emptying the bladder completely when peeing (with a neobladder)
• Renal function deterioration
• Stoma and bowel-related complications
• Narrowing of the joints
• Metabolic disorders 

How can life without a bladder be managed in the long term?

Removal of the bladder and urinary diversion is a life-changing operation. Patients will be able to get back to normal (physically) after the procedure. It is about getting used to a new normal. Early recognition of things not being quite right is key to early management. Attend regular follow-ups and follow the advice provided including dietary, fluid, and lifestyle modifications.

If you are considering getting your bladder removed, or would like to discuss alternatives, make sure to consult first with an esteemed consultant urologist like Dr Ashwin Sridhar. You can do just that by simply heading on over to his Top Doctors profile today.