If you’ve been diagnosed with muscle-invasive bladder cancer (MIBC) — a type of cancer in which tumors grow into the bladder muscle — your healthcare provider may recommend a radical cystectomy. This surgery removes the bladder and nearby lymph nodes, as well as some reproductive organs.

A radical cystectomy is a standard treatment when cancer involves the bladder muscle. This procedure is often considered more effective than nonsurgical treatments and may help you live longer after a bladder cancer diagnosis.

If you’re scheduled for a radical cystectomy or talking about this option with your healthcare provider, it can be helpful to understand what to expect. Here’s what you need to know about radical cystectomy for MIBC, including what happens before, during, and after surgery.

What Is a Radical Cystectomy?

A radical cystectomy is major surgery to remove the bladder and nearby lymph nodes. In some cases, part of the urethra (the tube that carries urine out of your body) may also be removed. Depending on where the cancer is located, your urologist may remove certain reproductive organs. This may include the prostate and seminal vesicles (glands that help make semen) or the uterus, cervix, ovaries, fallopian tubes, and — if needed — part of the vagina.

Every year, about 1 in 5 people in the U.S. with bladder cancer undergo a radical cystectomy.

During the surgery, your urologist will create a new way for urine to leave your body. This is called a urinary diversion and is often made using a small piece of intestine.

Every year, about 1 in 5 people in the United States with bladder cancer undergo a radical cystectomy. The primary goal of this surgery is to help people live longer. Studies show five-year survival rates after radical cystectomy ranging from 50 percent to 77 percent.

Survival rates are higher when chemotherapy is given before surgery. One study from Finland found that 66 percent of people were alive at five years and 55 percent were alive at 10 years after cystectomy.

How Doctors Determine if Radical Cystectomy Is Recommended

Muscle-invasive bladder cancer has a higher risk of metastasis (spreading) to other parts of the body, such as the liver, lungs, or bones. For this reason, radical cystectomy is often recommended if the cancer has not already spread beyond the bladder.

Bacillus Calmette-Guerin (BCG) is used to treat non-muscle-invasive bladder cancer (NMIBC), but it doesn’t work well for MIBC. For muscle-invasive disease, chemotherapy is often given before surgery. If surgery isn’t an option, chemotherapy or immunotherapy such as pembrolizumab (Keytruda) may be recommended first.

To determine if radical cystectomy is the best treatment for you, your healthcare provider will review details about your tumor. Certain features can make bladder cancer more likely to spread. Your care team may also look for genetic changes in the tumor to help guide treatment decisions. These results can help determine whether chemotherapy, immunotherapy, or surgery is likely to work best.

Your overall health is also important. People who are otherwise healthy and don’t have serious medical conditions may be good candidates for radical cystectomy. Still, the decision to proceed with this treatment option for MIBC is yours and should come after a thorough discussion with your urologist.

What To Expect Before a Radical Cystectomy

Before surgery, your healthcare provider will explain the procedure and how it may affect your ability to pass urine and your sexual function. Surgery can affect erections in men and can make sex uncomfortable for women, according to the American Cancer Society. It’s important to talk with your care team about these changes and what options may help afterward.

Everyone’s experience after a radical cystectomy is different, but recovery typically takes 10 to 12 weeks.

Your healthcare team will give you instructions on how to prepare for surgery, including:

• Whether you need blood work or other tests
• Which medications or supplements to stop
• What you can eat and drink, such as following a liquid diet for a day or two beforehand
• How active you should be before the procedure

You’ll also discuss urinary diversion — the new way urine will leave your body after your bladder is removed. Options include an ileal conduit, an Indiana pouch, or a neobladder.

Ileal Conduit

With an ileal conduit, your surgeon uses a small piece of your small intestine to create a tube that carries urine through an opening in your abdomen called a stoma. Urine drains into a small bag worn outside the body. An ostomy appliance (a protective covering with adhesive) fits over the stoma and connects to the bag to collect urine. This is the most common type of urinary diversion and usually takes less time than other options.

Indiana Pouch

An Indiana pouch is made from a section of your intestine. Your ureters (the tubes that carry urine from your kidneys) drain into a pouch created inside your body. Instead of wearing a bag, you insert a thin catheter through a small opening on your abdomen several times a day to empty the pouch. Some people prefer this option because there’s no external bag.

Neobladder

A neobladder is a new bladder pouch made from part of your intestine. Your ureters drain into this pouch, which is connected to your urethra. This allows you to pass urine through your urethra, similar to how you did before surgery. However, it can take time to learn how to use a neobladder. The new pouch may not hold much urine at first, which can mean frequent trips to the bathroom or waking up at night to urinate.

How To Handle Anxiety and Fear About a Radical Cystectomy

As your surgery date approaches, you may feel fear or anxiety. That’s completely normal. One study found that more than one-third of people experienced anxiety and depression before their radical cystectomy. Still, you don’t have to accept those feelings as something you must live with.

Talk with your healthcare provider about your concerns. Knowing what to expect during surgery and recovery can help calm your nerves. It’s also important to take care of yourself before surgery and follow your care team’s guidelines for diet, exercise, and medications.

If your fears are overwhelming or interfere with your life, consider speaking with a mental health professional. They can teach you stress management techniques such as deep breathing, progressive relaxation, or meditation. Surrounding yourself with supportive people who will listen to your concerns and help during your recovery may also provide comfort.

What To Expect During the Procedure

Once you’re prepped and ready for surgery, you’ll receive general anesthesia. This medication keeps you asleep during the procedure. Depending on their approach, your surgeon will make either one incision or several small cuts in your abdomen to remove your bladder.

In an open surgery, the surgeon makes one larger incision to reach the bladder and nearby lymph nodes. In a minimally invasive or laparoscopic surgery, they’ll make several small incisions and use special tools to remove the bladder. Some surgeons use robotic-assisted techniques, which may lead to less pain and faster recovery compared with open surgery.

After removing the bladder, lymph nodes, and other affected organs, the surgeon creates the urinary diversion. The entire surgery usually takes four to eight hours, followed by a hospital stay of five to 12 days.

What To Expect After Radical Cystectomy

Before you leave the hospital, you’ll receive written instructions on how to care for your incisions and when to call your care team — such as if you develop a fever, chills, discharge, or issues urinating. During recovery, you may feel some discomfort, but it should be manageable with pain medications and gradually improve as your body heals.

Everyone’s experience after a radical cystectomy is different, but recovery typically takes 10 to 12 weeks. As you heal, you’ll adjust to changes in how your body gets rid of urine. Depending on your type of urinary diversion, this may mean learning how to care for a stoma, empty an ostomy pouch, or insert a catheter. You may also need to adjust to changes in sexual function.

To help your recovery stay on track, keep all your follow-up appointments. Your healthcare team will make sure your incisions are healing well and your urine is draining properly. They’ll also check for signs of infection, address any concerns, and make referrals for follow-up care or interventions if needed.

Ask any questions you have about how your body is adjusting — especially if your quality of life is affected. Your healthcare team can help you find the support and solutions.

Join the Conversation

On MyBladderCancerTeam, people share their experiences with bladder cancer, get advice, and find support from others who understand.

If you’ve had a radical cystectomy, what steps did you take to recover and improve your quality of life? Let others know in the comments below.