Under What Circumstances Is the Bladder Removed?
Under What Circumstances Is the Bladder Removed?
Hello, I am Prof. Dr. Volkan İzol. One of the questions my patients ask most frequently in my urology practice is, “Under what circumstances is the bladder removed?” The bladder is a vital organ where urine is stored and then emptied in a controlled manner. However, due to certain medical conditions, it may be necessary to remove the bladder (radical cystectomy). In this article, I will explain in detail the conditions that require bladder removal, how the surgery is performed, life after surgery, and the discharge process.
The Importance of the Bladder and Bladder Disorders
The bladder, also known as the urinary bladder, stores urine filtered by the kidneys and allows us to empty it at regular intervals. A healthy bladder is a critical organ that determines our comfort in daily life thanks to its urine storage capacity, muscle structure, and neural control.
Diseases affecting the bladder, particularly bladder cancer, can be life-threatening. When diagnosed early, the chances of successful treatment are high; however, in advanced cases, removal of the bladder may be the only option.
Conditions Requiring Bladder Removal
- Muscle-Invasive Bladder Cancer
This is the most common reason for a cystectomy. If bladder cancer has reached the muscle layer of the bladder—that is, if it has become muscle-invasive—a cystectomy is recommended to prevent the spread of the disease.
- High-Risk Superficial Tumors
Radical cystectomy is considered when intravesical treatments such as BCG are insufficient for frequently recurring, multifocal, or high-grade superficial bladder tumors.
- Cancers Resistant to Radiation Therapy
In patients who have previously undergone radiation therapy and whose tumors cannot be controlled, a cystectomy may be necessary.
- Severe Bladder Dysfunction
Although rare, in cases such as irreversible bladder atrophy and painful bladder conditions (e.g., interstitial cystitis), a cystectomy can improve the patient’s quality of life.
Symptoms of Bladder Cancer and Conditions It May Be Confused With
The most common symptom of bladder cancer is blood in the urine. This condition is painless and is often overlooked by most patients. In addition:
- Frequent urination
- Burning sensation when urinating
- Urinary incontinence
- Frequent nighttime urination
Such symptoms may also be present. These findings can be mistaken for a urinary tract infection or an enlarged prostate. My most important recommendation is this: any patient with blood in their urine must consult a urologist. Early diagnosis is critical for preserving bladder function.
How Is a Cystectomy Performed?
Surgical Methods
A bladder removal procedure (radical cystectomy) can be performed using various techniques:
- Open Surgery: This is the traditional method, performed through a large incision in the lower abdomen.
- Laparoscopic Surgery: This minimally invasive procedure is performed using a camera and instruments inserted through small incisions, resulting in a shorter recovery time.
- Robotic Surgery: Using the Da Vinci robotic surgery system, it is possible to perform more precise and nerve-sparing surgeries under 3D visualization.
In general, I prefer robotic surgery for my patients who are suitable candidates. It offers the advantages of less blood loss, less pain, and a faster recovery.
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What Happens After a Bladder Removal?
When the bladder is removed, a new pathway is created so that the body can pass urine. This is called “urinary diversion”:
- Artificial Bladder (Orthotopic Neobladder): A new bladder is created from the small intestine, and the patient continues to urinate normally.
- Ileal Conduit (Bricker): A small opening (stoma) is created in the abdomen, and urine continuously flows into a bag.
- Cutaneous Reservoir: Urine fills a reservoir created in the intestine, which the patient empties at regular intervals using a catheter.
Every method has its advantages and disadvantages. Age, the tumor’s location, overall health, and the patient’s preference determine this choice.
Postoperative Process
The postoperative period is one of the topics patients are most curious about.
- Intensive Care: This is rarely necessary. Generally, the patient is transferred to a regular ward and is able to walk by that evening.
- Bowel Functions: They usually start working within 2–3 days.
- Discharge: Patients are discharged within 7–10 days after open surgery and within 5–7 days after robotic surgery.
- Return to Normal Life: Patients can usually resume their daily activities after 4–6 weeks. A return to heavy work and sports occurs after 6–8 weeks.
In my practice, patients who undergo surgery using robotic surgery are able to get up and move around sooner and recover more quickly.
Lifestyle and Tracking
Patients must attend regular follow-up appointments after surgery. Follow-up care includes blood tests, imaging studies, and, if necessary, endoscopic examinations. Patients are provided with detailed information on nutrition, fluid intake, and stoma care.
Conclusion
A cystectomy is a life-saving surgery when performed at the right time and using the correct technique. Early diagnosis and appropriate surgical techniques are critical to the patient’s long-term survival and quality of life.
Prof. Dr. Volkan İzol can evaluate you regarding the reasons for bladder removal, surgical methods, discharge, and the process of returning to normal life. Using robotic and laparoscopic techniques in modern urology, we offer our patients the most up-to-date treatments.
