Hello, I am Prof. Dr. Volkan İzol.

One of the questions my patients are most concerned about is this:

“Doctor, I was told I need to have my bladder removed. Is that really necessary? What will my life be like after that?”

This is a very natural question. Because getting a bladder transplant isn’t just a surgery—it’s a major decision that affects a person’s daily life, the way they urinate, and even their mental well-being.

But when performed on the right patient at the right time, it can save lives.

In this article, I will explain in detail the circumstances under which a bladder must be removed, the surgical methods used, what life is like after surgery, options for a new bladder (neobladder), and frequently asked questions.

The bladder is an elastic organ that stores urine from the kidneys and expels it when it contracts. It has an average capacity of 400–500 ml.

Removing the bladder means transferring this storage function to another structure. For this reason, thorough preoperative preparation and patient education are very important.

This is the most common reason for a bladder removal.

•If the cancer is on the surface of the bladder (superficial), it is usually removed by closed surgery (TUR-MT).

•However, if the tumor has invaded the muscle layer (T2 and higher tumors), radical cystectomy is the gold standard.

This surgery is performed to prevent the spread of cancer and save lives.

In tumors that continue to recur or become more aggressive despite BCG therapy, preserving the bladder is detrimental to the patient. In such cases, survival is much better if a cystectomy is performed early.

3. Cancer Resistant to Radiation Therapy or Chemotherapy

If organ-preserving treatments are unsuccessful, the bladder must be removed.

Severe traffic accidents or gunshot wounds can cause irreparable damage to the bladder. In such cases, the bladder is removed and a new urinary tract is created.

5. Severe Loss of Function

•Severe neurogenic bladder (e.g., following spinal cord injury)

•Uncontrolled bladder contractions, risk of kidney damage

•Shrunken, extremely painful bladders (e.g., severe interstitial cystitis)

In these cases, the bladder is removed to improve the patient’s quality of life and protect the kidneys.

The decision to remove the bladder is not based on a single PSA result or a single imaging study.

•Cystoscopy: Direct examination of the bladder using a camera

•Biopsy: Definitive diagnosis

•CT/MRI: Assessing the spread of cancer

•PET-CT: Are there metastases in distant organs?

•Multidisciplinary panel: An oncologist, a radiologist, and a urologist make a joint decision

I explain this process to my patients in detail and involve their families in the process. Making an informed decision makes it easier to follow postoperative instructions.

Surgical Techniques: Radical Cystectomy

Open Cystectomy

It is performed through a large incision in the abdomen. It is the traditional method, but the recovery time is longer.

Laparoscopic Cystectomy

It is performed by inserting a camera and long instruments through small incisions.

Advantages:

•Less blood loss

•Less pain

•Faster discharge

Robotic Mastectomy

It is becoming the gold standard today.

•3D and magnified image

•More precise sewing techniques

•Higher likelihood of nerve preservation

•Improved urinary continence and sexual function outcomes

As Prof. Dr. Volkan İzol, I prefer robotic surgery, especially for suitable patients. This is because it is the method that yields the best results in terms of both oncological and functional outcomes.

New Bladder (Orthotopic Neobladder)

One of the topics my patients are most curious about:

“Teacher, do I have to carry the bag?”

In suitable patients, we create a new bladder from the small intestine, enabling them to urinate naturally.

Advantages:

•No bag

•The urge to urinate is preserved

•The quality of life is much higher

Disadvantages:

•Training is required during the first few months

•Nocturnal urinary incontinence may occur

•It may be necessary to manually empty the bladder

Other Urinary Tract Alternatives

•Ileal Conduit (Bricker): A small pouch is placed in the abdomen. It is a simple and reliable method.

•Cutaneous Continence Diversion: An internal reservoir is created under the skin in the abdomen, and the patient empties it using a catheter.

The most appropriate option for each patient is evaluated on a case-by-case basis.

Postoperative Process

•Average length of hospital stay: 7–10 days

•The catheters are removed after 10–14 days

•Drinking plenty of fluids and staying active are very important during the first few weeks

•The bladder training process begins for patients who have undergone a bladder reconstruction

Side Effects and Long-Term Follow-Up

•Bleeding, infection, wound complications

•Intestinal problems

•Vitamin B12 deficiency

•Kidney function should be monitored over the long term

Regular follow-up can save lives. I recommend that my patients come in for a checkup every three months; the first two years are especially critical.

A bladder removal is a major life-changing procedure.

•It’s normal to feel anxiety and fear at first

•Most patients adjust to their new life within 3 to 6 months

•Social life, work life, and even sex life will largely return to normal

Supportive treatments and psychological counseling make this process easier.

•If my bladder is removed, do I have a chance of living without a colostomy bag?

Yes, a neobladder can be created in suitable patients.

•How will this affect my sex life?

Sexual function can be preserved through nerve-sparing surgery.

•Is this surgery very difficult?

Yes, it's a major surgery, but the success rate is very high when performed by experienced surgeons.

In my approach, the decision to remove the bladder should be tailored to the individual.

By using robotic surgery and nerve-sparing techniques, I aim to both completely remove the cancer and maintain the highest possible quality of life for my patients.

The decision to have a bladder removal is not an easy one, but in cases such as muscle-invasive bladder cancer, it can save a person’s life.

With modern surgical techniques, patients can adapt to their new lives with less pain, shorter hospital stays, and better functional outcomes.