Bladder cancer often begins in the cells lining the bladder. When cancer has invaded the bladder muscle or recurred, surgical removal of the bladder, known as a cystectomy, is a primary treatment option. This procedure aims to eliminate cancerous tissue and prevent its spread. Understanding bladder removal and subsequent adjustments is important for individuals facing this diagnosis.
Surgical Removal of the Bladder
Bladder removal aims to eradicate cancer that has progressed beyond superficial layers. When cancer cells penetrate the muscle layer, they can access lymphatic and vascular systems, increasing metastasis risk. A radical cystectomy is the most common procedure for muscle-invasive bladder cancer.
During this surgery, surrounding lymph nodes are also removed to check for cancer spread. In men, the prostate and seminal vesicles are typically removed. For women, a radical cystectomy usually includes the removal of the uterus, ovaries, fallopian tubes, and a portion of the vagina, depending on cancer extent. While partial cystectomy can be performed for very early, localized cancers, advanced disease often requires complete organ removal.
Methods of Urinary Diversion
After bladder removal, the body requires a new way to store and eliminate urine, known as urinary diversion. This re-establishes the urinary tract’s function. The choice of method depends on factors including patient health, kidney function, cancer stage, and lifestyle preferences. These methods are broadly categorized into incontinent and continent diversions.
Incontinent Diversions
Incontinent diversions involve a continuous flow of urine from the body into an external collection pouch. The most common type is the ileal conduit, or urostomy. In this procedure, a segment of the small intestine, usually the ileum, is detached while maintaining its blood supply. The ureters are connected to one end of this segment. The other end is brought through an opening in the abdominal wall, creating a stoma. Urine continuously drains into the ileal conduit and out through the stoma into a collection bag worn on the outside.
Continent Diversions
Continent diversions allow for internal storage of urine, providing more control over urination. One type is the continent cutaneous diversion, where an internal pouch is created from a section of the intestine. The ureters are connected to this pouch, which serves as an internal reservoir. A small stoma is created on the abdominal wall, but unlike the ileal conduit, this stoma has a valve mechanism to prevent leakage. Patients empty this internal pouch by inserting a catheter into the stoma at regular intervals, typically every 4 to 6 hours.
Another continent option is the neobladder, also known as an orthotopic bladder substitute. This procedure constructs a new bladder internally from a section of the patient’s intestine, usually the ileum. This reservoir is then connected directly to the urethra, allowing the patient to urinate more naturally. Patients may not experience the same sensation of bladder fullness as with a natural bladder, and some may need to perform self-catheterization. This option is not suitable for all patients, as it requires healthy kidney function, good manual dexterity, and a urethra free of cancer.
Life After Bladder Removal
The period immediately following bladder removal and urinary diversion surgery involves a hospital stay, typically five to seven days. During this time, pain management is a primary focus. Patients are closely monitored for infection or complications. Healthcare teams provide education on managing the new urinary diversion, including stoma care or catheterization techniques. Early mobilization and dietary adjustments are also part of the initial recovery phase.
Adjusting to life with a urinary diversion is a gradual process involving new routines and understanding altered body functions. For individuals with an ileal conduit, mastering stoma care, including changing the appliance and managing skin integrity, becomes a daily task. Those with continent diversions learn to self-catheterize at prescribed intervals to empty their internal pouch, or in the case of a neobladder, they retrain their pelvic floor muscles for urination. This retraining can take weeks to months, and some individuals may experience temporary incontinence, especially at night.
Daily life often requires modifications, though most individuals can resume many previous activities. Dietary considerations may involve avoiding foods that cause gas or odor, particularly for those with a stoma. Clothing choices might need slight adjustments to comfortably accommodate an external pouch. Physical activity can generally be resumed once cleared by a healthcare provider. Intimacy is also possible after recovery, though some discussions and adjustments may be necessary with a partner. Regular follow-up appointments with oncology and urology teams are important for monitoring recovery, managing long-term issues, and screening for cancer recurrence.