Cystectomy, Neobladder, and Urinary Diversion for Bladder Cancer

Urologic surgeon Eugene Cha

If you have bladder cancer that has grown into the muscle, our doctors may perform a cystectomy. This procedure removes a portion of the bladder or the entire bladder.

Partial Cystectomy

A partial cystectomy removes only a portion of the bladder. It may be an option if the cancer has grown into the bladder wall in just one area and that region can be easily removed without impairing the bladder’s function.

Radical Cystectomy

If the cancer has spread into the muscle of the bladder wall or beyond, the best chance for a long-term cure is usually a radical cystectomy to remove the bladder. A surgeon may also take out the surrounding lymph nodes and nearby organs. This can help prevent the cancer from coming back or spreading to other areas of the body.

  • For men, the surgeon will need to remove the prostate and seminal vesicles (the tubelike glands behind the bladder that secrete many components of sperm).
  • For women, the surgeon will remove the uterus, ovaries, and part of the vagina.

It is important to be treated by a surgeon who has a great deal of experience. Studies have repeatedly shown that people who have surgeons who have done a large number of procedures have better outcomes. Our urologic surgeons perform around 250 radical cystectomy operations annually — an extremely high number. We also offer minimally invasive procedures for certain people. This includes robot-assisted surgery. Minimally invasive procedures can result in less pain and blood loss. People may have smaller scars and a faster recovery.

Neobladder and Urinary Diversion

If the bladder is removed through a radical cystectomy, our surgeons may be able to create a new bladder, called a neobladder. If that’s not possible, we will create a new way for the urine to leave the body. This is called urinary diversion. Which best procedure is best depends on your prior medical history, the location of the cancer, and your personal preferences.

Neobladder

A neobladder is built from part of the small intestine and is connected to the urethra (the duct through which urine leaves the body). People with a neobladder are most likely able to urinate normally. A small percentage of people may need to use a catheter to drain urine from their neobladder, but they don’t need a pouch outside the body to collect urine.

If the urethra has been removed, our surgeons can connect the neobladder to a small opening in the skin of the abdominal wall. This opening is called a stoma. That’s where urine will be drained from the body.

We may be able to use minimally invasive approaches to perform neobladder surgery, including robot-assisted methods.

Memorial Sloan Kettering Alvin Goh, an expert in robotic surgery.
Bladder Cancer Surgery: A New Era of Reconstruction
MSK has expanded its bladder cancer surgery options with new robotic methods for constructing a substitute bladder.
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Urinary Diversion (Indiana Pouch)

If a neobladder is not recommended, doctors can create other ways for the urine to leave the body. Our surgeons may create something called an Indiana pouch. In this approach, a small pouch is formed from the bowel. The pouch is connected to a tiny opening (stoma) created in the abdomen. A catheter inserted into the stoma drains the urine into a bag. This needs to be done a few times a day. Urinary diversion eliminates the need for a urine collection bag outside the body. Often, surgeons can create the opening in the belly button so it is less visible to others.

Ileal Conduit

For some people whose bladder has been removed, an ileal conduit is the best option. After the bladder is taken out, a surgeon then removes a small section of the intestine called the ileum. One end of the ileum is attached to the ureters, the tubes that carry urine from the kidneys to the bladder. The other end is attached to a surgically created stoma. Urine flows through the ileal conduit into a bag outside the body. Our doctors consider many factors when deciding on a neobladder, an Indiana pouch, or an ileal conduit.

Support in Caring for a Stoma

If a stoma is created as part of the surgery, our nurses will provide expert support throughout the recovery period. A specialized nurse will answer your questions and teach you how to manage and care for the stoma. We will also explain how to properly change the urine collection pouch. After you leave the hospital, you will have follow-up appointments. If needed, you can have visits to your home to help ensure that your recovery continues.

Deciding on Treatment after a Cystectomy

Our bladder cancer nomogram is a prediction tool. It is intended to help doctors and people with bladder cancer decide whether additional treatment is needed after the bladder has been removed.

The nomogram is designed to estimate the risk of the cancer coming back. In consultation with a doctor, people with cancer can use this tool to understand the likelihood of remaining free of bladder cancer five years after surgical treatment.

Use our Bladder Cancer: Risk of Recurrence Following Surgery nomogram.