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Care After a Cystectomy (Bladder Removal)

What is a cystectomy?

A cystectomy is an operation to remove the urinary bladder.

It is a treatment for some cancers in the pelvic area. The pelvic area is just below your belly button. Some patients may need their bladder removed because of treatment complications. These complications include hemorrhagic cystitis (swelling and bleeding in the bladder) or bladder fibrosis (scar tissue in the bladder).

How urine leaves the body after a cystectomy

After a cystectomy, surgeons create a new way for urine (pee) to leave the body. It is called diversion.

There are 3 main types: incontinent diversion, cutaneous continent diversion, and orthotopic neobladder.

  1. Incontinent diversion

    In incontinent diversion, urine is stored in a pouch (bag) worn outside the body. Your care provider will teach you how to empty, clean, and change this external pouch.

  2. Cutaneous continent diversion

    In cutaneous continent diversion, urine is stored in a pouch inside the body. This internal pouch is connected to an opening to the outside of the body called a stoma. Your care provider will teach you how to use a catheter to remove urine from the pouch. 

  3. Orthotopic neobladder

    The orthotopic neobladder procedure makes a new bladder (neobladder) from the bowel. Some people with a neobladder can urinate naturally. Others may need a catheter to remove urine from their bladder.

Possible side effects after cystectomy

External and internal pouches

Potential issues include:

  • Urine may leak. It can irritate the skin and cause infection.
  • Scar tissue may form. This tissue can block the flow of urine from the kidneys.
  • The urine may flow back into the kidney (reflux). This increases the risk of a urinary tract infection (UTI) or kidney stones.

Neobladder

Incontinence, the inability to control the passage of urine, may occur.

  • Pelvic muscle-strengthening exercises may help. These include Kegel exercises. 
  • Pressure testing may help inform treatment decisions. It measures how much pressure your bladder needs to urinate and how quickly your urine flows at that pressure.

Abnormal levels of chemicals and fats

Surgery that involves part of the small intestine can cause abnormal levels of chemicals and fats in the blood. These problems may cause diarrhea, kidney stones, and low levels of Vitamin B12.

Sexual problems

Cystectomy may also increase the risk of sexual problems in both men and women. Surgery and medicines may help.

Health care after cystectomy

Tips for health care after cystectomy include:

  • See a urologist regularly. A urologist is a doctor who diagnoses and treats urinary system problems. You may also need to see an enterostomal therapy nurse (ET nurse). They may advise about skin care and supplies. The nurse can also help solve any problems with catheters.
  • Have a yearly blood test to check vitamin B12 level, starting 5 years after bladder surgery (if it involved part of the small intestine). 
  • Call your provider if you have fever, pain in the mid-back or side, blood in your urine, or severe skin irritation.
  • Seek help from your care provider right away if you have problems putting in a catheter (self-catheterization). This may mean the pouch has ruptured or will rupture if it cannot drain properly. This can cause serious infection.
  • Contact your care provider right away if you vomit or have belly pain. These symptoms may indicate a bowel blockage.

Questions to ask your provider about cystectomy

  • What are possible problems that can happen after my bladder is removed?
  • Is there anything I can do to prevent problems from happening?
  • Whom do I call if I have questions about my care?
  • What tests should I have after my cystectomy?

Key points about cystectomy

  • A cystectomy is an operation to remove the urinary bladder.
  • Bladder removal may be part of a treatment or used to treat complications of treatment. 
  • After cystectomy, surgeons will create a new pathway to remove urine (pee) from the body. 
  • Complications may include urine leakage, skin irritation, abnormal levels of chemicals and fat in the blood, or sexual problems. Treatments are available.
  • See a urologist regularly. Seek medical help if you have symptoms of complications. Symptoms may include pain, fever, vomiting, blood in urine, or severe skin irritation. 

—
Reviewed: August 2023

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