Bladder Cancer

Surgery

There are two main surgeries for bladder cancer.

• Transurethral resection (TUR) removes cancerous cells from the bladder.
• Cystectomy removes all or part of the bladder if cancer has spread into the bladder muscle.

Surgery Choices

Surgery to remove cancer

Transurethral resection (TUR) is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder.

Surgery to remove bladder

Cystectomy is the surgical removal of all (total or radical cystectomy) or part (partial cystectomy) of the bladder. It is used to treat bladder cancer that has spread into the bladder wall (stages II and III) as either a first occurrence or as a cancer that returns (recurs) following initial treatment. A radical cystectomy removes the whole bladder as well as the surrounding pelvic organs.

Following surgery to remove the bladder, your surgeon will create a new channel for urine to pass from your body.¹³

• An ileal conduit (also called a noncontinent diversion) uses a segment of your intestine to create a channel that connects your ureters to a surgically created opening (stoma) on your abdomen. This procedure is called a urostomy. After a urostomy, the urine passes from the ureters through the conduit and out the opening into a plastic bag that is attached to your skin. You will empty the bag 3 or 4 times a day, and a larger bag that allows for longer storage can be worn overnight. You will also learn how to care for your urostomy.
• A continent reservoir (continent diversion) uses a segment of your intestine to create a storage pouch that is attached inside your abdomen. There are two types of internal continent reservoirs.
  • Abdominal diversion reservoir. The pouch inside the abdomen connects to an opening (stoma) in the skin. This is another form of urostomy. The opening is smaller than the opening for an ileal conduit, and because there is a pouch inside the abdomen no bag needs to be worn outside your body. You will need to pass a catheter through the opening to release the urine several times a day and during the night.
  • Orthotopic diversion. The pouch in this procedure is sometimes called a bladder substitution reservoir. If your urethra was not removed as part of the cystectomy, you may be able to have this type of procedure. In an orthotopic diversion, the pouch is attached to your ureters at one end and your urethra at the other. This allows you to pass urine through the same opening as you did before surgery. Some people may need to use a catheter to release the urine.

Noncontinent diversions are simpler and may have fewer complications either right after surgery or in the coming months and years. Continent diversion reservoirs eliminate the need for a urine storage bag to be worn outside the body.

What To Think About

Side effects from your surgery can include problems with bowel functioning, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.

Adhesions may develop after surgery, and a bowel obstruction may occur as a complication if surgery was extensive.

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Author:	Shannon Erstad, MBA/MPH	Last Updated: May 25, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Philip Belitsky, MD, FRCSC - Urology
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