The most common surgery is an operation to remove your bladder (radical cystectomy). You may be given chemotherapy to shrink the cancer before your surgery.

Cystectomy can be carried out in people with invasive or locally advanced bladder cancer (see staging). Some people whose bladder cancer has come back after being treated with radiotherapy may be able to have a cystectomy (known as salvage cystectomy).

Cystectomy is also sometimes done in people with early (superficial) bladder cancer that keeps coming back after treatment.

Your doctor will explain which is the most appropriate type of operation for you.

Occasionally an operation to remove part of the bladder (partial cystectomy) is done. After this operation people are able to pass urine as usual. However, as the bladder is smaller and holds less urine, they need to pass urine more often.

In this operation the whole bladder is removed. In men, the prostate gland, part of the urethra, and the lymph nodes close to the bladder are also taken away.

In women, the bladder, womb, cervix, nearby lymph nodes and part of the urethra are removed.

Men usually become impotent (unable to get or maintain an erection) and women may find that sensations during sexual intercourse are different from before the operation. The effects of surgery on your sex life are explained in more detail later on in this section.

After your bladder has been removed the urine made by your kidneys will need to be collected and stored differently from before. Your surgeon will make a new storage place for urine or sometimes make a new bladder. This is done at the same time as your cystectomy. There are several different operations which you may have: urostomy, bladder reconstruction, continent urinary diversion or uro-rectal conduit.

Your surgeon will explain which type of operation is most suitable for you and give you more information about what is involved. These operations are only carried out by specialist surgeons.

A urostomy (or ileal conduit) is the most common operation and it means your urine will be collected in a bag. During the operation the surgeon removes a section of your small bowel and joins the two ureters to one end of it. They bring the other open end of the bowel out through the skin of your abdomen.

The ureters carry urine from your kidneys to the piece of bowel. The piece of small bowel (ileum) acts as a channel (conduit) to take the urine to the surface of the abdomen. This is why this operation is sometimes called an ileal conduit. The small hole on the surface of the abdomen, through which the urine now passes out of the body, is called a stoma.

A flat, watertight bag is placed over the stoma to collect your urine. It’s kept in place with a special type of adhesive. The bag will fill with urine and you’ll need to empty it regularly. Your specialist stoma nurse will show you how to take care of it.

See further information on living with a urostomy.

This operation means you don’t need to have a bag to collect your urine. A piece of your bowel is used to make a pouch to store your urine inside your abdomen. The ureters are attached to the piece of bowel and carry urine from your kidneys to be stored in the new pouch. The end of the piece of bowel is brought out onto the surface of the abdomen to make a stoma.

A small plastic tube (catheter) can be passed through the stoma into the pouch about 4 or 5 times a day to drain the urine. This is called self-catheterisation. Although you may feel worried about doing this at first, most people find they are good at managing self-catheterisation and at caring for their stoma. Your specialist stoma nurse will show you how to do this.

Sometimes your bladder can be replaced by using a piece of the small or large bowel to make a new bladder. This operation is known as bladder reconstruction (neobladder) and it can be done in different ways.

Bladder reconstruction is not suitable for everyone. For example, it’s only done if there is no spread of the cancer to the urethra (the tube though which urine is passed). Your doctor will explain if this type of operation is appropriate for you.

Usually your doctor will remove a piece of your bowel, make it into a balloon-shaped sac and stitch it to the top of your urethra. The ureters are stitched into this new bladder so that urine drains directly into it from the kidneys.

The new bladder is emptied by flexing your abdominal muscles. You will need to remember to empty it, as you will have lost the nerves that tell you when your bladder is full. Sometimes this nerve loss can lead to incontinence (leaking of urine), especially when you are asleep. Twenty to thirty per cent of people (2 or 3 out of every 10 people) will have some incontinence.

Most people learn how to pass urine through the urethra. However, some people find it difficult and need to drain the urine regularly by passing a catheter (small plastic tube) into the urethra.

There’s a small risk that the cancer could come back in the urethra, so you will have a test every year to check for this. The test is similar to having a cystoscopy.

It is sometimes possible to divert the urine into the rectum so that both urine and stools are passed through the back passage (rectum). If this is done the person does not need a urostomy bag, or to pass a catheter to drain the urine.

You may be nursed in the intensive care or high-dependency unit immediately after your operation. This is routine in many hospitals and does not mean your operation has gone badly or that there are complications.

The nurses will encourage you to start moving about as soon as possible after your operation. This is an essential part of your recovery, as it helps to prevent problems such as chest infections or blood clots. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. A nurse or a physiotherapist can help you to do the exercises.

Drips and drains

After the operation you may have some of the following in place for a short time:

• A drip (intravenous infusion) to give you fluids until you are able to eat and drink again. It may also be used to give you painkillers.
• A drainage tube in your wound/wounds to prevent swelling and allow the wound to heal properly. This is taken out after a few days.
• A naso-gastric (NG) tube. This is a tube that passes down your nose into your stomach or small bowel and allows fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours.
• A fine tube going into your back (epidural). This may be used to give you drugs that numb the nerves and stop you feeling pain.

Pain

After your operation you will need painkilling drugs for a few days. These may be given into a vein (intravenously), into the space around your spinal cord (epidural), into a muscle (intramuscularly) or as tablets.

To begin with you may be given intravenous painkilling drugs through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller. You may also have a hand control with a button you can press if you are in pain. This is called patient controlled analgesia (PCA). It’s designed so that you can’t overdose, so it’s okay to press it whenever you are uncomfortable.

Some people are given painkilling drugs into the space around the spinal cord (epidural) to numb the nerves. The drugs are often given through a syringe and tubing attached to an electronic pump.

If you are in pain, let your nurses and doctors know as soon as possible. This will help them to give you the combination and dose of painkillers that is right for you.

Going home

How long you are in hospital for after your operation will depend on the type of operation you’ve had. It can range from 7 to 14 days. If you think that you might have problems when you go home – if you live alone or have flights of stairs to climb, for example – tell your nurse or social worker. They can arrange help for you before you leave hospital.

Your doctor will advise you about how soon you will be able to get back to doing normal things, like work, driving, shopping, gardening or playing sport. This will vary depending on the surgery you have had and on you as a person.

Before you leave hospital you will be given an outpatient appointment to attend. This will be a check-up for a few weeks after your surgery and is a good time to discuss any problems you may have after your operation.

You may be worried about adapting to changes in how your body looks, and how you may feel about your body after any surgery. This is a normal reaction, as over the years we all develop an image in our minds about what our bodies look like. Although we may not be completely satisfied with that image, most people are used to the way they see themselves. It can be upsetting to have that image changed permanently by surgery (especially if you have a stoma).

You may also be concerned about the effect that the surgery will have on your relationships. You may be worried about rejection, continuing to have sex with your partner, or starting a new relationship. Many people find that they feel reassured once they’re able to talk about their fears with their partner. Talking about your feelings can also help you to feel clearer about what worries you the most. It gives other people the chance to understand more about how you are feeling. You can also talk to your doctor or nurse about your concerns and support organisations can also give support.