Muscle-invasive Bladder Cancer

Radical Cystectomy

Radical Cystectomy

Removal of the urinary bladder (cystectomy)

The mainstay of treatment for muscle-invasive bladder cancer is surgical removal of the urinary bladder.

Your doctor has several reasons for recommending removal of the whole bladder:

  • Presence of a muscle-invasive tumour
  • Presence of a tumour that grows aggressively (high grade), that has multiple cancerous areas (multifocal), or that is superficial, but has recurred after chemotherapy or immunotherapy
  • Failure of or recurrence after a bladder-sparing approach (chemoradiation) or the occurrence of major side-effects
  • Symptoms like bleeding or pain in patients with incurable disease

To evaluate and weight your individual risk of undergoing removal of the bladder, work with your physician to consult a multidisciplinary team (for example, urologist, surgeon, anaesthesiologist, nurse practitioner, general practitioner, cardiologist).

Factors like your biological age (your body’s performance as it ages, measured as performance status or life expectancy) and other diseases that you have (diabetes, heart disease, high blood pressure) are also important. Patients older than 80 years of age have more problems recovering from such an operation. Physicians use special indexed scores to assess the risk of patients undergoing this stressful operation.

Prior abdominal surgery or radiotherapy makes surgery more difficult but is rarely a reason not to have surgery. Being overweight does not influence survival after surgery but does influence the risk of complications from wound healing.

Removal of the urinary bladder includes removal of the bladder, the endings of the ureters and the pelvic lymph nodes. Depending on factors like tumour location and type of urinary diversion part of the adjacent gender-specific organs (the prostate and seminal vesicles in men; the entire urethra, adjacent vagina, and uterus in women) are removed. Men should be aware that prostate cancer is sometimes found in removed prostates but generally does not affect long-term survival or treatment.

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Read more about radical cystectomy, how it is performed, how to prepare for the procedure and what to expect after the procedure.