Understanding Bladder Cancer: Surgery
Surgery is the main treatment for bladder cancer. However, there are many different types of surgeries. Some involve removing your entire bladder. Others are less invasive. Your doctor will recommend the surgery based on the stage of your bladder cancer.
In this section, we’ll look at the most common kinds of surgery for bladder cancer.
This surgery is usually done for early stage bladder cancer. In this procedure, a thin tube with a lens and a light is inserted into the bladder through the urethra. This tube is called a resectoscope. For this surgery, you will be given general anesthesia so that you will be in a deep sleep. Or the lower part of your body will be numbed. There is no need for an incision (cut) in the abdomen. Once surgery is over, you may need to have another procedure. For example, sometimes it is necessary to burn the base of the tumor through a cystoscope or laser treatment.
You may have some bleeding or mild pain after surgery. Most patients return home the same day or one day after surgery. You should be able to carry on your normal activities in 2 weeks or less.
This treatment usually works well. However, bladder cancer often returns in other parts of your bladder. If the surgery has to be repeated several times, you may experience scarring. This can make it hard for your bladder to hold urine. You may experience incontinence (losing control of your urine).
If the bladder cancer is invasive, you may need all or part of your bladder removed. This surgery is called a cystectomy. There are 2 types:
- Partial cystectomy: when only part of bladder is removed
- Radical cystectomy: when the whole bladder is removed
When the whole bladder is taken out, nearby lymph nodes are also removed. If you are a man, your prostate will also be removed. If you are a woman, the surgeon will also remove the:
- Womb (uterus)
- Fallopian tubes
- Small part of the vagina
These surgeries are usually done through an incision (cut) in your belly. This is the best path to your bladder. In some cases, the surgery can be done through several smaller cuts. These are done with long, thin instruments. One of these instruments has a tiny video camera on its end. This procedure is called laparoscopic or “keyhole” surgery.
With either surgery, you will be given general anesthesia and in a deep sleep. You will have to stay in the hospital for around a week. You should be able to return to your normal activities in 4 to 6 weeks.
Some doctors recommend transurethral resection surgery, together with radiation therapy and chemotherapy, to treat early stage bladder cancers. Others think that cystectomy is the best treatment. You should discuss these options with your doctor.
If your entire bladder is removed, you will need another way to store and remove urine. There are several ways to do this:
Ileal conduit: A short piece of your bowel (small intestine) is removed. Then it’s used to connect your ureters to the skin of your abdomen through a small opening. This opening is called a urostomy or stoma. A small bag is put over the stoma to catch your urine. The bag has to be emptied every time it becomes full.
- Continent diversion: This method does not require you to have a bag outside your body. Instead, the surgeon creates a sac from a small piece of your intestine. Your ureters are attached to the sac. A drainage tube (catheter) is put into the hole so that urine can empty through it. There are newer methods of surgery that can redirect the urine back you’re your urethra. This is done by creating a new bladder out of a piece of your intestine. This process makes the urination process the most normal.
All bladder surgeries have some possible side effects like:
- Urinary infections
- Urine leakage
- Urine flow blockage
- Sexual problems if radical bladder surgery is done. These differ for men and women:
Some women choose to have the vagina rebuild. This is known as vaginal reconstruction. Radical cystectomy can also affect a woman's ability to have an orgasm. The 2 nerve bundles on each side of the vagina can be damaged. You should ask your doctor whether these nerve bundles can be left in place. If the doctor removes the end of the urethra, the clitoris may lose its blood supply. This makes sexual arousal more difficult. You can talk to your doctor about whether the end of the urethra can be saved.