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by Dr. C.H. Weaver M.D. (04/2018)

A radical cystectomy, a surgery that involves removal of the bladder, is a common treatment for cancer of the bladder. Persons who have a radical cystectomy also undergo a procedure to design a new way for the body to store and pass urine. Recently, researchers in California said that a large percent of bladder cancer survivors report that their quality of life after a radical cystectomy is good.

Cancer of the bladder is characterized by the presence of cancer cells in the bladder, the organ that is located in the lower abdomen and that serves to store urine. Treatment options, which depend on the stage of the cancer (extent of disease at diagnosis) and a number of other factors, may include surgery, radiation therapy, chemotherapy, and/or biologic therapy to help the immune system fight the cancer. One type of surgery that is commonly used, especially for persons who have stage III or IV bladder cancer, is called a radical cystectomy.

A radical cystectomy consists of the surgical removal of the bladder as well as the tissue and some of the organs around it. For men, the prostate and the seminal vesicles, and possibly the urethra, are often removed. For women, the uterus, ovaries, fallopian tubes, part of the vagina, and the urethra are often removed.

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A pelvic lymph node dissection, removal of the lymph nodes in the pelvis, may also be performed to determine whether the cancer has spread to these lymph nodes. Pelvic lymph node dissection adds little to the overall morbidity of radical cystectomy, improves staging accuracy and may be curative in some patients with minimal lymph node involvement.

Because the bladder is removed, doctors must design an alternate way for the body to store and pass urine. This is often referred to as a urinary diversion technique. Sometimes, this entails using part of the intestine to construct a tube that carries urine to an opening (called a stoma) to the outside of the body. The procedure to construct this stoma is called an ostomy or urostomy. Many researchers have also been studying more permanent ways to allow urine to be stored and passed without use of the bladder to help improve urinary function and quality of life. This often involves creating a substitute bladder, sometimes called a neobladder.

Researchers from Stanford University evaluated how individuals who undergo a radical cystectomy and some form of urinary diversion view their quality of life afterward. Of 224 patients, the majority reported a good overall quality of life, little emotional distress, and few problems with social, physical, or functional activity. The most frequent problem associated with the urinary diversion procedure was sexual functioning. Men who elected to have a penile prosthesis (surgical placement of an artificial penis) had a higher degree of sexual functioning and satisfaction than men who opted not to have this procedure.

The researchers concluded that the majority of long-term survivors of bladder cancer report that their quality of life is good, regardless of the type of urinary diversion technique used. Persons with bladder cancer who have undergone or are considering undergoing a radical cystectomy may wish to talk with their doctor about the risks and benefits of the various available urinary diversion techniques or of participating in a clinical trial in which other promising new strategies are being studied.