What is a cystectomy?  

• Cystectomy is removal of the bladder.  

• Removal of the bladder is accompanied by creation of a urinary diversion, which is a new structure for urine to drain into.  

• The most common indication for cystectomy is high grade or invasive bladder cancer.  

• Other indications include a small contracted bladder, severe radiation damage, and fistulas between the bladder and other pelvic organs.  

• If there is cancer suspected or present, often the oncology and reconstructive teams work together to complete this procedure.  

What are options for urinary diversion?  

• After the bladder is removed, the ureters (the tubes that drain the kidneys) must be reconnected to another structure that will allow drainage of urine.  

• Urinary diversions may be either continent or incontinent.  

• Ileal conduit: a small segment of the small intestine (ileum) is used to create a stoma on the abdominal wall. This is the most common type of diversion.  

  • This is an incontinent diversion.   

  • The stoma is usually in the right lower part of your abdominal wall.  

  • You will have to wear a pouch on your abdomen at all times to collect the urine.  

• Neobladder: a portion of the small intestine is reshaped to form a new bladder-like pouch.  

  • This neobladder is connected to the urethra or another exit point, allowing the patient to urinate more normally.   

  • This is a continent diversion - there are no external appliances that need to be worn.  

• T pouch / Koch pouch / Indiana pouch: a reservoir is created using a portion of the small and/or large intestine, and a valve mechanism is constructed to control urine flow.   

  • The patient empties the reservoir by catheterizing through a small opening in the abdomen.   

  • This is a continent diversion - there are no external appliances that need to be worn. 

What are potential risks of this procedure?  

• Bowel obstruction (<10%).  

• Bowel leak (<2%).  

• Urine leak (<5%).  

• Scar tissue or stricture at the connection between the ureters and the conduit (<10%).  

• Parastomal hernia (30%).   

What should I expect during my hospital stay?  

• Plan on a hospital stay of 5-7 days.  

• Ambulation (walking around) is encouraged to facilitate healing. A physical therapist will work with you daily.  

• Depending on the type of urinary diversion created, you may have a catheter and/or a drain in the abdomen.  

• There will be small plastic tubes called stents that extend up into both kidneys to help the connections between the ureters and diversion heal.  

• Your bowels may take a few days to wake up so your diet will be somewhat limited the first few days after surgery.  

  • Some people experience delayed return of bowel function and need decompression of their stomach with a tube through their nose. 

• You will meet with an ostomy nurse while you are in the hospital to learn how to pouch your stoma (if indicated).  

  • There are many different pouching systems and accessories, and the nurses will help determine which may work best for your anatomy.  

What will my recovery after discharge be like?  

• You will discharge home with pain medications and stool softeners. 

• No lifting more than 10lb or strenuous activity for 6 weeks after surgery. This will help to decrease your hernia risk.  

• Stents will come out of the kidneys 2-3 weeks after surgery. This is a simple procedure that will be done in clinic.  

• An ultrasound of the kidneys will be done about 1 month after stents are removed to ensure that there is no swelling of the kidneys.