Removing the Bladder (Cystectomy) and Urinary Diversion

In a "radical cystectomy," the surgeon removes the bladder and usually some nearby structures where cancer could spread. Nearby lymph nodes are commonly removed too, so they can be checked.

• For men, the prostate is usually removed as well.
• For women, nearby organs such as part of the reproductive tract may be removed, depending on the situation.

Because the bladder stores urine, removing it means the surgeon must also build a new path for urine to leave the body. That path is called a "urinary diversion," and there is more than one kind.

The surgeon uses a piece of your own intestine to build the new path.

1. Ileal conduit (with a urostomy bag)

A short piece of intestine carries urine to a small opening on the belly called a "stoma." Urine drains continuously into a bag worn on the outside of the belly. It is the simplest and most common option and needs no catheters to empty.

2. Neobladder (a new bladder inside)

A pouch built from intestine is connected to the urethra, so you can urinate in a fairly normal way through the same place as before. There is no outside bag. It takes training to use, control is not always perfect, and some people need to pass a catheter at times to empty it fully.

3. Continent pouch (emptied with a catheter)

An internal pouch built from intestine holds urine, with a small hidden opening on the belly that stays closed on its own. Instead of wearing a bag, you empty it several times a day by passing a thin catheter into the opening.

If you have an ileal conduit, you will wear an ostomy "appliance." Here is what that means, in plain terms.

The parts

• The stoma — the small, pink, moist opening on your belly. It has no feeling, and it is normal for it to look a little swollen at first and to shrink over the first weeks.
• The barrier (wafer) — a sticky patch that protects the skin and holds the bag on.
• The pouch (bag) — collects urine and has a drain valve at the bottom.

Emptying and changing — the routine

• Emptying: open the valve to drain the bag into the toilet through the day, and connect to a larger bag at night so you do not have to get up.
• Changing: the whole appliance is changed on a schedule (often every few days), and an ostomy nurse teaches you exactly how.

Skin care

Keeping the skin around the stoma clean and dry, and getting a good fit, prevents most irritation. Tell your care team or ostomy nurse if the skin gets red, sore, or itchy — it usually has an easy fix.

Everyday life — reassurance

• Clothing: the appliance is flat and hidden under normal clothes. Most people cannot tell you are wearing one.
• Travel: people with urostomies travel, fly, and go on vacation — you pack extra supplies and carry some in your bag.
• Swimming and showering: you can shower and swim with the appliance on.
• Intimacy: a urostomy does not have to end your sex life. Many couples adjust comfortably; your care team or an ostomy nurse can offer practical tips.

This is major surgery, and recovery takes time and patience. Everyone's course is different; these are general ideas, not a schedule for you.

• In the hospital: a stay of several days is usual, focused on getting your bowels working again, managing pain, walking early, and learning the basics of your diversion.
• Early weeks at home: tiredness is expected. You build back strength gradually and avoid heavy lifting while you heal.
• Learning curve: caring for a new diversion feels awkward at first and gets much easier with practice and support.
• Enhanced-recovery programs: many centers use a set of steps ("enhanced recovery," sometimes called ERAS) designed to help you recover faster and more comfortably. Ask if yours uses one.

• Which diversion types am I a candidate for, and which do you recommend for me — and why?
• What would daily life and upkeep look like with each choice?
• Can I meet an ostomy nurse before surgery?
• Do you use an enhanced-recovery program?
• How long is the hospital stay and recovery likely to be for me?
• How will this affect intimacy and sexual function, and what can help?
• Will I need any treatment before or after surgery, such as chemotherapy?
• How is my recovery and my cancer followed afterward?

Bring this list to your surgery consult. The visit-prep page has more question lists you can print.