Bladder Cancer Procedures

Before bladder cancer surgery, you will undergo a thorough preoperative assessment to ensure the procedure is safe and tailored to your needs.

This includes:

• Medical history and examination: Dr. Farag will review your overall health, medications, and any previous surgeries.

• Blood tests: To check general health, kidney function, and blood count.

• Urine tests: To check for infection or blood in the urine.

• Imaging: Scans such as CT, MRI, or ultrasound may be performed to assess the bladder, surrounding organs, and lymph nodes.

• Cystoscopy: A procedure where a thin camera is inserted into the bladder to visualise the tumour and guide treatment planning.

• Pre-anaesthetic assessment

• Medication review: Certain medications, like blood thinners, may need to be adjusted before surgery.

You will also receive instructions regarding fasting, medications, and what to expect on the day of surgery. The aim of this assessment is to reduce risks, optimise recovery, and achieve the best possible surgical outcome.

For patients having a cystectomy:

A cystectomy is a major operation that can take several hours to perform and requires a significant recovery period. To ensure the surgery is as safe as possible, patients undergo a series of preoperative tests and investigations.

These usually include:

• Blood and urine tests to check overall health and kidney function

• Imaging scans to assess the bladder and surrounding organs

• Cardiorespiratory assessments, such as an echocardiogram or lung function tests (spirometry), to ensure your heart and lungs are fit for surgery

For patients having cystectomy for bladder cancer, additional imaging is performed to check for spread of the disease. This typically involves CT scans, and in some cases, PET or MRI scans. MRI provides detailed information about the tumour and its relationship to nearby structures, helping your surgical team plan the safest and most effective approach.

On the day of your bladder cancer procedure, you will arrive at the hospital a few hours before your scheduled operation. After check-in, the nursing team will take you to your room and complete routine preoperative checks.

You will meet Dr. Farag and your anaesthetist, who will confirm the procedure, answer any final questions, and explain what to expect. A small intravenous line (drip) will be placed. You will then be taken to the operating theatre and given a general anaesthetic, so you will be asleep and comfortable throughout the procedure.

The type of surgery will depend on your tumour and may include:

• TURBT (Transurethral Resection of Bladder Tumour): Tumours are removed through a thin instrument inserted into the bladder.

• Cystectomy (partial or radical): Part or all of the bladder is removed using open or laparoscopic techniques.

After surgery, you will wake up in the recovery area, where your vital signs and comfort will be closely monitored. You may have a urinary catheter and possibly a drain near the surgical site. Pain is usually well controlled with medication. You will be encouraged to start moving and drinking fluids as soon as it is safe.

Dr. Farag will review your progress, explain how the procedure went, and guide you through the next steps in your recovery.

Cystectomy in Male Patients:

For men with bladder cancer, the typical cystectomy involves:

• Removal of the bladder and prostate, as these organs are connected

• Removal of the pelvic lymph nodes

For men who wish to preserve sexual function, certain techniques may be considered:

• Prostate capsule-sparing: The outer “shell” of the prostate is left intact to help preserve the nerves responsible for erections

• Nerve-sparing: The nerves responsible for erections are carefully preserved

Cystectomy in Female Patients:

For women with bladder cancer, the standard cystectomy usually involves:

• Removal of the bladder

• Removal of part of the vagina and urethra

• Removal of the pelvic lymph nodes

In some cases, it may be possible to preserve the vagina, uterus, and ovaries, depending on the patient’s age, cancer characteristics, and personal wishes regarding sexual function.

Urinary Diversion After Cystectomy

After the bladder is removed, urine needs a new pathway to exit the body. Options include:

• Urostomy: The most common diversion. A small opening (“stoma”) is created on the abdomen, and urine is collected in an external bag. This option is generally simple, has a lower complication rate, and is easy to manage. Dr Farag and specialist nurses will discuss the pros and cons with you.

• Neobladder: A more complex diversion in which a new bladder is created using a segment of bowel. Not all patients are suitable, and it requires significant aftercare. If appropriate, Dr Farag will discuss this option in detail, including its benefits and considerations.

A cystectomy is a major operation, and like all major surgery, it carries risks. Thankfully, most serious complications are rare, but it is common to experience minor issues during your hospital stay and recovery at home.

Key Potential Risks

• Cancer not being fully cured: The risk depends on your cancer stage and type. Dr. Farag will discuss this with you.

• Infertility: Men will no longer be able to father children due to the removal of structures that carry sperm.

• Loss of sexual function:

  • Men may lose ejaculation and, unless nerve-sparing surgery is possible, erections.

  • Women may experience narrowing of the vaginal canal unless vaginal-sparing surgery is suitable.

• Bleeding: Severe bleeding is uncommon. Blood transfusions are required in less than 2% of patients, often in those with low haemoglobin.

• Infections: Urinary infections are the most common (up to one-third of patients). Wound, chest, or intra-abdominal infections can occur in up to 5% of patients, sometimes requiring antibiotics or minor procedures.

• Injury to other structures: Rarely (<1%), organs in the abdomen or pelvis such as bowel, nerves, or blood vessels can be injured.

• Rectal injury: Very rare (<0.5%), more likely in patients who have had prior radiotherapy. Most injuries can be repaired during surgery.

• Numbness: Mild numbness in the lower abdomen or groin is common and usually improves over time.

Complications Related to Urinary Diversion

Using the small intestine to create a neobladder or ileal conduit involves joining the ureters to the bowel and reconnecting the bowel. Early complications during the hospital stay can include:

• Paralytic ileus: Temporary bowel “shutdown” causing bloating, nausea, or vomiting (20–30%). May require a nasogastric tube or IV fluids.

• Urine leakage: Can occur at the joins; small leaks often heal on their own, but larger leaks may require drainage.

• Bowel leakage: Very rare (1–2%) but serious. May require antibiotics or, in severe cases, emergency surgery.

Late or Long-Term Complications

• Incisional hernia: Rare (<2%), where internal tissue protrudes through an incision.

• Stoma problems: Hernia around the stoma (15–20%) or narrowing may require corrective surgery.

• Nutritional issues: Vitamin deficiencies, diarrhoea, or other bowel-related problems (<2%).

• Ureteral scarring: Can occur in up to 9% of patients; usually monitored with scans and occasionally requires surgery.

Lymph Node Surgery Complications

• Lymphocele: Fluid collection in the pelvis (~3%), sometimes requiring minor drainage.

• Lymphoedema: Persistent leg swelling is rare (1%), managed with compression, elevation, and specialist support.

Medical or Anaesthetic Risks

Because bladder cancer often affects older adults or those with other health problems, surgery carries rare but important risks:

• Heart attack or stroke: <1%

• Blood clots: Deep vein thrombosis (DVT) 5%, pulmonary embolism (PE) 3%

• Death within 90 days: Rare (<1–2%), usually related to existing health conditions or complications

While cystectomy is a major operation with potential risks, most patients recover well. Your team will monitor you closely, provide detailed guidance during recovery, and support you through any complications that may arise.

Recovery after a cystectomy is gradual, as this is a major operation. While most patients recover steadily, it’s normal to experience some discomfort and changes in daily routines during the first few weeks.

Hospital Stay

• Most patients stay 5–10 days, depending on the type of surgery and recovery progress.

• You will usually have a urinary catheter in place, and possibly a drain near the surgical site. Nurses will teach you how to care for these.

• Pain is typically managed with medication, and gentle movement is encouraged to help circulation and healing.

Early Recovery at Home

• Fatigue: Feeling tired is common for the first few weeks.

• Diet and hydration: Eat a balanced diet and drink plenty of fluids to support healing and bowel function.

• Activity: Light activity and walking are encouraged. Avoid heavy lifting and strenuous exercise for 6–8 weeks.

• Urinary function: For patients with a urostomy, you will learn to manage the stoma and collection bag. For a neobladder, Dr. Farag and your nursing team will guide you on how to empty it safely.

Managing Side Effects

• Urinary or bowel changes: Temporary changes are common. Urgency, frequency, or mild leakage can occur and usually improve over time.

• Wound care: Incisions or stoma sites require regular cleaning and monitoring for infection.

• Dietary adjustments: Some patients may experience changes in digestion, especially after bowel reconstruction.

Follow-Up After Cystectomy

After a cystectomy, ongoing follow-up is an essential part of recovery and long-term care. The goal is to monitor your recovery, check kidney function, and detect any recurrence of cancer early.

Early Follow-Up

• Postoperative review: You will have an appointment with Dr. Farag a few weeks after surgery to check your recovery, remove catheters or drains if still in place, and discuss any pathology results.

• Blood tests: Kidney function and overall health will be monitored regularly.

• Stoma or neobladder care: Nurses will review your urinary diversion and teach you how to manage it safely at home.

Long-Term Monitoring

• Cancer surveillance: Depending on your cancer stage and risk factors, follow-up will include periodic scans, cystoscopy (if part of the bladder remains), and lab tests to detect recurrence.

• Kidney and urinary tract monitoring: Imaging and blood tests are performed to ensure your urinary system is functioning well.

• Health and lifestyle: Regular check-ins may include advice on diet, activity, and managing long-term effects of surgery.

Typical Timeline

• Initially, follow-up appointments are every 3–6 months.

• Over time, if recovery is stable and no recurrence is detected, visits may become annual.

• The duration of follow-up usually extends for 5 years or more, depending on your individual risk.