A cystectomy is a surgical procedure to remove all or part of the urinary bladder. It is most commonly performed to treat bladder cancer, but it may also be done for other conditions like chronic bladder inflammation, severe trauma, or congenital defects.
Types of Cystectomy:
Partial Cystectomy – Only a part of the bladder is removed (usually if cancer is small and localized).
Radical Cystectomy – The entire bladder is removed.
Bladder Cancer (most common reason)
Especially if it is muscle-invasive or high-grade and does not respond to treatments like chemotherapy or BCG.
Severe Bladder Damage
From trauma, radiation therapy, or chronic inflammation.
Painful Bladder Conditions
Such as interstitial cystitis that does not respond to other treatments.
Birth Defects
Rarely, if the bladder is malformed and non-functional.
Neurological Bladder Dysfunction
In very severe cases where the bladder cannot empty or store urine properly, and other treatments fail.
Step-by-Step Cystectomy Procedure
1. Pre-operative Preparation
Medical tests: Blood work, urine tests, imaging (CT/MRI), EKG.
Bowel prep: Cleansing of the intestines if a urinary diversion will involve the bowel.
Fasting: No food or drink for several hours before surgery.
Consent: Patient is informed and signs surgical consent.
2. Anesthesia
General anesthesia is administered — the patient is fully unconscious and pain-free.
3. Positioning and Sterile Prep
The patient is positioned on the operating table.
The abdomen is cleaned and sterilized to prevent infection.
4. Surgical Incision
Open surgery: A vertical incision is made in the lower abdomen.
Minimally invasive (laparoscopic/robotic): Several small incisions are made for camera and tools.
5. Removal of the Bladder and Nearby Organs
The bladder is carefully detached from surrounding tissues.
In men: Bladder + prostate + seminal vesicles are removed
In women: Bladder + uterus + part of vagina + ovaries (sometimes) are removed.
6. Lymph Node Dissection
Pelvic lymph nodes are removed and sent for testing to check for cancer spread.
7. Urinary Diversion Construction
Since the bladder is gone, a new pathway for urine is created:
Ileal conduit: A piece of small intestine is used to connect ureters to a stoma (urine collects in a bag).
Neobladder: A new bladder made from intestine, connected to the urethra (you can urinate normally).
Continent reservoir: A pouch is created inside the body and emptied using a catheter.
8. Closure
All internal structures are checked for leaks.
Drains and catheters are placed.
The incision is closed with sutures or staples.
9. Recovery in Hospital
ICU or recovery room monitoring.
Pain control, IV fluids, and gradual reintroduction of diet.
Patient learns to manage urine diversion (if needed).
Hospital stay: usually 5–10 days.
