If the whole bladder is removed, the operation is called a complete cystectomy. In men, the prostate gland, part of the urethra, and the lymph nodes close to the bladder are also removed. In women, as well as the bladder, the womb, cervix, nearby lymph nodes and part of the urethra are removed. After a cystectomy women will not be able to have children.
Men usually become impotent (are 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 this section.
A new storage place for urine will need to be created using a urostomy, bladder reconstruction, continent urinary diversion or uro-rectal conduit.
Urostomy
The most common way of making a new drainage channel for urine is to make a urostomy. While you are under a general anaesthetic, the doctor will remove a section of your small bowel, join the two ureters to one end of it and bring the other, open end out through the skin of your abdomen.
This operation makes an ileal conduit. It is called this because the piece of small bowel (ileum) acts as a channel (conduit) to take the urine from the ureters and bring it to the surface of the abdomen. 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 opening on the abdomen (stoma) to collect the urine. It is kept in place with a special type of glue. The bag will fill with urine and will need to be emptied regularly.
See further information on living with a urostomy.
Bladder reconstruction
Sometimes the bladder can be replaced by using a piece of the small or large intestine to make a completely new bladder. This operation is known as bladder reconstruction, and it can be done in different ways.
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. It is then possible for most people to learn how to pass urine through the urethra, rather than needing to wear a stoma bag or use a catheter.
The new bladder is emptied by flexing your abdominal muscles, but 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 30% of patients (2 or 3 out of every 10 people) will have some incontinence.
Bladder reconstruction is not suitable for everyone. Your doctor can advise whether it is possible for you to have bladder reconstruction. Most people are able to 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 into the urethra.
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