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Urinary Bladder Removal (for Urinary Bladder Cancer)

Last updated April 3, 2019

Approved by: Krish Tangella MD, MBA, FCAP

Illustration of Bladder cancer in a female.


Background Information:

What are the other Names for the Procedure?

  • Bladder Excision
  • Cystectomy
  • Urinary Bladder Excision

What is the Urinary Bladder Removal surgical procedure?

Urinary Bladder Removal or Cystectomy involves the surgical removal of the:

  • Urinary bladder and reconstruction of the urinary tract to aid in urine discharge
  • In some cases, the procedure may also involve the removal of neighboring tissue and organs

What part of the Body does the Procedure involve?

The body part involved in Urinary Bladder Removal, depends on the sex of the patient:

  • In women: Urinary bladder, urethra, ureters, cervix, vagina, and the small intestine
  • In men: Urinary bladder, urethra, ureters, seminal vesicles, and the small intestine

Why is the Urinary Bladder Removal surgical procedure Performed?

Urinary Bladder Removal surgical procedure is commonly performed to treat cancer of the urinary bladder.

What are some Alternative Choices for the Procedure?

Radiation therapy and/or chemotherapy are usually used as an alternative to treat bladder cancers. However, in some cases these may not prove to be as effective as a surgery.

What are the Recent Advances in the Procedure?

The recent advances to the procedure are in the use of laparoscopic techniques.

What is the Cost of performing the Urinary Bladder Removal surgical procedure?

The cost of Urinary Bladder Removal (for Urinary Bladder Cancer) procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Urinary Bladder Removal and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://urology.jhu.edu/bladder/Cystectomy.pdf

http://www.mdguidelines.com/cystectomy/prognosis

http://www.mayoclinic.org/cystectomy/

Prior to Urinary Bladder Removal surgical procedure:

How is the Urinary Bladder Removal surgical procedure Performed?

  • During a Bladder Removal procedure; an incision is made in the abdomen, the muscles, tissue and the abdominal organs are moved aside to locate/isolate the bladder
  • The bladder is then separated from the ureters after dissecting and closing major blood vessels that supply blood to the affected area
  • The bladder is removed, along with the neighboring tissue and organs; if there is such a requirement
  • The healthy portion of the ureters is examined for any signs of cancer, or other diseases
  • It is then re-implanted into a small segment of the small bowel (ileum), which is then separated from the rest of the bowel and then brought out as a stoma to the skin surface
  • Bowel continuity is then reestablished by making a connection between the two cut ends of the small bowel
  • The abdomen is closed layer by layer with sutures, after properly repositioning the organs, muscles, and tissues

Where is the Procedure Performed?

A Urinary Bladder Removal procedure is performed in a hospital. The patient is admitted, undergoes the procedure and is discharged as per the instruction of the physician.

Who Performs the Procedure?

The surgery is performed by a general surgeon or an urologist, assisted by an anesthesiologist.

How long will the Procedure take?

The surgery may take anywhere between 2-6 hours.

What do you need to tell your Physician, before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc. 

What Preparations are needed, prior to the Procedure?

The preparations needed prior to Urinary Bladder Removal procedure, include the following:

  • Before the surgery the patient is administered laxatives and enemas, to completely empty the bowels
  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Avoid application of any cosmetics, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Urinary Bladder Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Urinary Bladder Removal surgical procedure?

Before a Bladder Removal procedure, the patient has to undergo certain tests such as:

  • Routine blood and urine analysis
  • Cystoscopy
  • X-ray of kidneys
  • Ultrasound
  • CT scan

The physician may suggest further tests depending on the health of the patient and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Urinary Bladder Removal procedure?
  • Why is this procedure necessary? How will this procedure help?
  • What does the procedure involve?
  • Will the surgical procedure ensure that the cancer will not recur?
  • What are the alternatives to the procedure?
  • How soon should I get it done? Is there an emergency?
  • To what extent will the surgery affect normal urination process?
  • Will the stoma (ileal conduit) be permanent? Will it cause any problem in the future?
  • What are the complications associated with the surgery?
  • What are the risks involved?
  • Who are the medical personnel involved in this procedure?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • What are the costs involved?

During the Urinary Bladder Removal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia is administered during the procedure.

How much Blood will you lose, during the Procedure?

  • Urinary Bladder Removal is a complex surgical procedure involving the lower abdomen, parts of the reproductory and excretory organs; it is difficult to quantify the amount of blood loss
  • If complications arise during the surgery, then it could lead to a further loss of blood

What are the possible Risks and Complications during the Urinary Bladder Removal surgical procedure?

The possible risks or complications that may arise during the surgery are:

  • Excessive bleeding
  • Infection
  • Problems with reconstruction or formation of stoma
  • Cardiopulmonary complications
  • Accidental damage to the neighboring tissue or organ
  • Blood clot formation in the legs

What Post-Operative Care is needed at the Healthcare Facility after the Urinary Bladder Removal surgical procedure?

The healthcare facility must have an intensive care unit (ICU) attached, for immediate post-operative care and recovery, if needed. Apart from this, no particular care is needed unless complications arise.

After the Urinary Bladder Removal surgical procedure:

What are the possible Risks and Complications after the Urinary Bladder Removal surgical procedure?

Post Bladder Removal surgery, the following complications may arise:

  • Infection in the surgical wound
  • Urine leakage inside the abdomen
  • Urinary tract infection
  • Loss of blood supply to the stoma
  • Bowel blockage
  • Hernia
  • Impotence in men
  • Adhesions
  • Sexual problems

What is the Prognosis after the Surgery?

The 5-year survival rate for patients who have undergone the procedure varies, and is based on the stage of cancer when treatment occurs. During the early stages of cancer, the survival rate is very high; whereas after metastases, it is found to be lower.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Pain around the surgical wound
  • Swelling and redness
  • Bleeding or drainage
  • Fever
  • Dizziness
  • Signs of infection
  • Any discomfort

What Post-Operative Care is needed at Home after the Urinary Bladder Removal surgical procedure?

At home, the following post-operative care is recommended, after Urinary Bladder Removal procedure:

  • Keep the wound clean and dry
  • Avoid eating foods that may cause an irritation to your stomach
  • Have a liquid diet till your physician advises otherwise
  • Avoid strenuous exercises
  • Complete the course of medication, as prescribed by your surgeon/physician
  • Adapt and understand the change in urinal/bowel habits

How long does it normally take to fully recover, from the Procedure?

It takes about 6-8 weeks to completely recover from the surgical procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The bladder and surrounding tissues are taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Urinary Bladder Removal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital
  • A general surgeon or an urologist
  • An anesthesiologist
  • A pathologist

The patient is advised to inquire and confirm the type of billing, before a Urinary Bladder Removal surgical procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 7, 2013
Last updated: April 3, 2019