Surgery is the initial procedure in the treatment of many solid cancers. Surgery and other invasive procedures work by removing cancerous tissues.
There are four types of surgical procedures available to treat bladder cancer:
You and your doctor will discuss which procedure is appropriate for you, based on your health, your tumor grade and stage, how many tumors are present in the bladder, and other factors.
This type of bladder surgery can usually be used to treat very early forms of bladder cancer. Instead of using an open abdominal incision, all of the instruments are passed through the urethra and into the bladder. A cystoscope is used to visualize the inside of the bladder and locate the tumor. The tumor may be removed through burning (fulguration), laser, cutting, or by the application of destructive chemicals.
You and your doctor will discuss in advance whether you will need general anesthesia for this surgery, or whether you can receive regional anesthesia (for example, a spinal anesthetic that only numbs your body from the waist down).
Your surgeon will fill your bladder with fluid. Then, the cystoscope is inserted through the urethra and into the bladder. The surgeon uses this instrument to view the inside of the bladder and to remove the tumor. After this is done, a urinary catheter (tube to drain urine into a bag) will be left in your urethra and bladder. Your urine may look bloody for days or even weeks.
After a transurethral bladder tumor resection, you may go home that day or stay in the hospital for several days. This may depend on your baseline level of health and how the procedure goes.
Transurethral bladder tumor resection can be completely curative for patients with very superficial, early stage bladder cancer. For patients with higher tumor grades, or more invasive types of cancer, other types of treatment ( chemotherapy, radiation, or more extensive surgery) may be needed in addition to transurethral bladder tumor resection.
The following complications may occur with this procedure:
You will need several weeks to recover from a transurethral bladder tumor resection and begin to feel well again. You’ll probably be sent home with a urinary catheter in your bladder. You’ll be asked to drink a lot of water, in order to flush pieces of the tumor out with the urine. You will notice bloody urine from time to time, although this should decrease as you begin to recover. If bleeding increases, it may be because you have too rapidly accelerated your activity level; lie down and rest. If the bleeding continues, call your doctor.
Once the urinary catheter is removed, you may have trouble controlling your bladder for a time.
While you are recovering, get plenty of sleep, don’t lift anything heavy (10 pounds or more), and consult your doctor about when you can begin to participate in your usual activities, including driving.
This surgery uses an open abdominal incision to expose the bladder and remove the tumor. Depending on the tumor’s grade, whether it has invaded the muscle, and the size of the tumor, part (partial cystectomy) or all (total cystectomy) of the bladder may be removed. The procedure is called a “‘radical cystectomy” if other neighboring organs and tissue are also removed, such as lymph nodes, urethra, prostate, uterus, fallopian tubes, and/or ovaries.
If your entire bladder must be removed, the surgeon may try to create a new bladder out of a piece of your intestine, or may create an opening in your abdomen (stoma) to allow your urine to pass into a bag that you will need to wear.
You’ll be given general anesthesia for this procedure. You’ll also be given medicines and fluids through an intravenous tube, and you’ll have a tube put down your throat to allow a machine to breathe for you while you are anesthetized. A tube placed through your nose and into your stomach will drain any digestive juices that accumulate during the surgery, and may be left in place after surgery.
An incision will be made across the lower part of your abdomen. Depending on the situation, either just the tumor and part of your bladder will be removed, or your entire bladder and other neighboring organs will be removed.
If your entire bladder is removed, part of the time you spend in surgery will be used to help create a new reservoir for your urine, either using a piece of your intestine, or sending the urine out of your body through a new opening created in your abdomen (stoma) and into a bag that you will wear externally.
Depending on the extent of the surgery, your baseline level of health prior to surgery, and how speedily you recover from your surgery, you’ll probably stay in the hospital for 2-7 days.
Cystectomy may provide a cure for some types of bladder cancer. Other types of bladder cancer will require additional treatments, such as radiation. In general, cystectomy is used when the cancer has invaded the bladder wall; additional treatment is required when examination of the tissue removed at surgery indicates that the tumor has spread into the surrounding pelvis.
After a cystectomy, there is a risk for certain complications, including the following:
As with any major surgery, you will need 6-8 weeks for recovery. During this time, get plenty of sleep, don’t lift anything heavy (over 10 pounds), and consult your surgeon about when you can begin to participate in your usual activities, including driving.
In addition, you'll receive the following care after your surgery:
Campell’s Urology. 8th ed. New York, NY: Elsevier Science; 2002: 2732-2765.
Cecil Textbook of Medicine. Philadelphia, PA: WB Saunders Company; 2002: 633-634.
Conn’s Current Therapy. 54th ed. Philadelphia, PA: WB Saunders Company; 2002: 720-721.
What you need to know about bladder cancer. National Cancer Institute website. Available at http://www.cancer.gov/cancerinfo/wyntk/bladder . Accessed December 2002.
Last reviewed September 2012 by Mohei Abouzied, MD
Last Updated: 09/26/2012