Surgery for Bladder Cancer

There are several types of bladder cancer surgery. The best option for each patient is determined by the bladder cancer stage.

Transurethral Resection: This is a minimally invasive bladder cancer surgery often chosen as an initial treatment for those in the early-stage of bladder cancer. A slender scope is placed in the bladder through the urethra to remove the cancerous cells with an electric current. The urologist may augment the procedure with blue light cystoscopy to improve his/her ability to see and remove all cancers in the bladder.

Partial cystectomy: A partial cystectomy may be an option for cancer involving only one area near the top of the bladder, away from other important structures. In this procedure, the bladder is spared by removing only the portion of the bladder with the tumor. The resulting hole in the bladder wall is then stitched closed.

Radical Cystectomy with Urinary Diversion: This surgery is used for advanced used in advanced bladder cancer cases where the entire bladder needs to be removed because the tumor has invaded the deep layers of the bladder. An extended pelvic lymph node dissection is performed in tandem to make sure any secondary malignant growth in this area is eradicated. Men also have the prostate, seminal vesicles and lymph nodes removed so that the bladder cancer does not return. Women may lose portions or all of the urethra, vagina, lymph nodes, uterus, fallopian tubes and ovaries.

After the radical cystectomy, a new way to drain urine from the body must be created. There are three common methods for doing this:

  • Ileal conduit: In this procedure, a short section of the small intestine is used to create a drainage system. The ureters (ducts which normally pass urine from the kidney to the bladder) are re-routed to one end of a small intestine segment which connects to an opening on the surface of the abdomen (called a stoma) on the other end. Here, the urine drains into a collecting pouch or ostomy bag. This is a relatively quick and easy procedure requiring less recovery time than other treatments.
  • Continent urinary reservoir: This procedure is similar to the Ileal conduit, however it requires an extra step to surgically create an internal pouch formed from the intestines. The ureters connect to the pouch which allows urine to pass from the kidneys and collect inside the body. Rather than flowing into an ostomy bag, the urine drains only when a catheter is inserted through the stoma into the pouch.
  • Orthotopic neobladder: This is the most invasive of the three procedures and requires more recovery time. A new bladder pouch (created from intestine) is placed in the exact same location as a real bladder. The ureters are connected to one end of the pouch where the urine collects internally. The urethra is then connected to the other end of the pouch, allowing one to void through normal channels.
Robotic Radical Cystectomy with Intracorporeal Urinary Diversion: Historically, this surgery has been performed through an open incision in the patient’s abdomen. Now, Emory has fellowship-trained urologists who specialize in robotic surgery to remove the patient’s bladder through smaller incisions so the patient can recover quicker with less blood loss and pain. At most other centers that perform robotic radical cystectomy, the bladder is removed robotically but the patient is then opened through a standard incision to perform the urinary diversion, thereby losing any advantages of the robotic procedure. At Emory the entire procedure is performed robotically for all types of urinary diversion (intracorporeal urinary diversion) to help maximize potential benefits of robotic surgery for the patient. Enhanced Recovery After Surgery (ERAS) Protocols: Emory has created a specific pathway for patients undergoing radical cystectomy with urinary diversion to help minimize complications and speed up recovery after the surgery so patients can return to their lives as quickly and safely as possible. This pathway addresses all patient needs before, during, and after the operation, including:
  • Specific dietary and other recommendations to prepare the patient for surgery
  • Special medications and teamwork between the surgeon and anesthesiologist during the operation
  • Daily goals and expectations after the surgery - while patients are in the hospital as well as for the first couple of months at home after the patient leaves the hospital