What is Cystectomy? Complete removal of the bladder, adjacent organs and the pelvic lymph nodes, called 'Radical Cystectomy' is the standard treatment for patients with invasive bladder cancer. Bladder sparing procedures are available, like transurethral resection, chemotherapy and radiation, and 'Segmental Cystectomy', wherein selected patients are chosen to remove only the diseased part of the bladder. Bladder sparing procedures do not guarantee control of the disease as well as the radical cystectomy.

What is Transurethral Resection of Bladder Tumors or TURBT? Transurethral resection (TUR) is used to establish the diagnosis and extent of muscle-invasive disease. Papillary Ta tumors, selected T1 tumors and Tcis are treated. The use of TUR is ideal for patients with lower disease stages, especially for a person with a small, solitary tumor. Follow up is necessary to detect recurrence.

What to expect after TURBT? The one concern your urologist is going to have after TURBT is recurrence, even years after the initial diagnosis. Nearly 70% of the patients with superficial bladder cancer develop recurrence. However, only about 15% develop a more lethal form of the tumor.

What is a Segmental or Partial Cystectomy? Segmental cystectomy involves removal of only the diseased portion of the bladder. Staging of the tumor is also achieved simultaneously while preserving bladder and sexual functions. Follow up is necessary to detect recurrence. Very few patients meet the criteria to undergo this option.

What Chemotherapy might be used? The role of systemic chemotherapy and its impact on outcome continues to evolve. A four drug combination, called the M-VAC protocol, consisting of methotrexate, vinblastine, doxorubicin and cisplatin is used. MVAC has a problem of toxicity. Newer approaches use gemcitabine and cisplatin with paclitaxel as an alternative. These are less toxic. Improvements in chemotherapy have allowed for aggressive approaches in some patients, when combined with radical cystectomy. Medical oncology at RPCI offers all the different chemotherapeutic options at consultation if indicated.

Adjuvant treatment is substance or treatment that is added to the standard treatment to help improve its effectiveness. Neoadjuvant refers to treatment given before the standard treatment so it has a better outcome. Palliative treatment refers to treatment designed to control the disease rather than cure it. This is used in incurable cases.

When would Radiation be used? Radiation is the primary choice for patients who have invasive bladder cancer but are unable to undergo cystectomy. It is preceded by transurethral resection to remove all visible bladder cancer or as much as possible.

Radical Cystectomy
Cystectomy is a major surgery and after you have reviewed your options with your urologist, you may decide that removal of the bladder offers the best chance of cure. It is helpful to understand in some detail the complexities of the surgery, the specifics of bladder removal, the reasons for lengthy recovery and, of course, the potential hazards.  

Roswell Park  was the first facility in Buffalo and among the first centers in the country to offer state-of-the-art robotic-assisted surgery to patients with bladder cancer. The pioneering technique offers these patients a less invasive treatment option that has several potential advantages over traditional open surgery. Patients may experience less post-operative pain, resume bowel activity sooner, resume day-to-day activity more quickly and stay fewer days in the hospital. Nerve preservation is possible in healthy, sexually active men with robotic assistance.

What is Urostomy / Ileal conduit? The most common method to make a passageway for urine is by the formation of an ileal conduit or urostomy. A small section of the ileum (third part of the small intestine) is used to join the ureters from the kidney to the skin of the abdominal wall to form a conduit for urine to pass into a storage bag outside. The remaining ileum is joined together again.

What’s a Continent pouch or reservoir? A continent pouch or new bladder is fashioned from a part of the bowel and used if the urethra is removed in the operation. Here you do not have to wear a bag. Instead you will be taught how to drain the urine by passing a small catheter into the new bladder.

What is an Orthotopic Neobladder? Under certain circumstances, when the urethra can be preserved after biopsy shows no cancer during surgery, a part of the small intestine is used to make a new pouch that is connected to the remaining part of the urethra. The requirement of a stoma is eliminated and urine passes out of the body through the natural urethra. Bladder empties normally, but you may have to learn to use a catheter to drain the urine several times a day and train your abdominal muscles to empty the neobladder.

In select women, it may be possible to preserve the anterior vaginal wall and urethra.

These operations are all major procedures and your urologist should discuss it in detail with you, your partner or family. The team at Roswell Park will advise and help you, before and after your operation, and teach you to look after your urostomy, bladder or pouch. They will be able to introduce you to someone who has already had your operation so that you can find out how other people cope, and give you information on support groups in your area.