What is a radical cystectomy?

Treatment of locally advanced bladder cancer frequently involves major surgery called a radical cystectomy in which the urologist removes the entire bladder and part of the urethra, the urinary tube leading to the genitals. In male patients, the prostate is also removed, and that procedure is called a radical cystoprostatectomy. Female patients usually have their uterus, fallopian tubes, ovaries, and a portion of the vagina removed. A lymph node dissection may be performed at the time of surgery. Most commonly, after removal of the bladder, the urologic surgeon will then use a portion of the small bowel to divert the patient's urine. Sometimes, a portion of the bowel is reconstructed to form a new bladder, referred to as an orthotopic neobladder. Radical cystectomy is a major surgery, but curative for the majority of patients who are in otherwise good health and able to tolerate it. Five-year survival rates for patients range from as high as 90% down to as low as 40%, the latter usually in patients with tumors that invade deeply through the muscle wall beyond the bladder. Fortunately, this situation isn't common. Side effects of this surgery include bleeding, infection, urinary incontinence (leakage), vitamin B12 deficiency, stone formation at the surgical staple line, and sexual problems.