Questions to Ask Your Urologist Before Undergoing a Cystectomy for Bladder Cancer

Karl Marvin Tan MD

May 16, 2021

If you’ve recently been diagnosed with advanced bladder cancer, you may have been advised that you’ll need a cystectomy (a surgical operation that removes all or part of your bladder) to slow or stop the cancer from spreading.

Your doctor / urologist will take time to explain everything you need to know about cystectomy – its risks, benefits, long-term outlook, success rate, among others.

It can be devastating and daunting to learn that you have an aggressive form of cancer, but bear in mind that you muster all of your strength to participate in your own care. Although the result cannot be assured, a cystectomy can be just what you need to live a long and healthy life.

In order to effectively manage your treatment, you must ask the right questions. When considering a cystectomy, here are some questions to ask your urologist.

Male torso with kidneys, ureters, and urethra showing total cystectomy with incontinent urinary diversion http://my.clevelandclinic.org/services/urinary_reconstruction_and_diversion/hic_urinary_reconstruction_and_diversion.aspx Smith’s General Urology 16th ed.

What Does Cystectomy Involve?

Cystectomy is a highly complex operation that normally requires four to six hours to complete and is done under general anesthesia.

If required, your UROLOGIST will remove your bladder as well as other organs such as your prostate. Depending on the doctor’s preferences and the specific situation, there could be one major incision or many small ones. After that, he’ll conduct urinary reconstruction and diversion to give you a new way to excrete urine.

You’ll then spend several hours in rehab before being moved to a hospital bed. You will stay in the hospital for up to a week to rest and recover. Pain medicine, incision care, ambulation, fluids, and postoperative care instructions, including how to use your new urinary system, will be given to you.

How can I urinate without a bladder?

Based on the form of cystectomy you had, your UROLOGIST will prescribe a urinary diversion. The three forms of urinary reconstruction and diversion are as follows:

  • A fragment of small intestine, or ileum, is used to create a “new” urinary bladder (an ileal conduit passes urine to the outside of your body through a stoma and into a collection bag)
  • Creation of a continent urinary reservoir with a piece of small intestine (your new bladder must be emptied with a catheter)
  • Creation of a neobladder from a larger section of ileum (this option most closely resembles normal urination)

All these options are proven to empty the bladder efficiently and completely. 

What are the Possible Complications of the Procedure?

As with any other surgical procedure, cystectomy does have some complications, albeit very rare. These include the following: Pneumonia, Blood clots, Incisional infection, Urinary tract infection (UTI), Bleeding, Urinary incontinence.

The following are signs and symptoms of infection, so make sure to reach out to Dr. Avila right away if you experience any of these:

  • Back pain
  • Cloudy, dark urine
  • Fever
  • More mucus in your pee (having some white mucus threads is normal)
  • Upset stomach
  • Very strong-smelling urine
  • Vomiting

The treatment necessitates a lifetime adjustment. Following a cystectomy, you’ll need to adjust to a new way of passing urine and going about your everyday activities, such as bathing and traveling.

With enough time, you’ll be able to resume your normal routine before the surgery, but you’ll be carrying a urostomy pouch (to collect your urine) with you everywhere you go. You are free to return to work, exercise, and even swim once you have received Urologist approval.