A cystectomy is surgery to remove all or part of the urinary bladder. It is most commonly performed to treat bladder cancer that has invaded the muscle wall, though it can also address severe non-cancerous bladder conditions. Because the bladder stores urine, removing it means surgeons must also create a new way for urine to leave the body, a step called urinary diversion.
Why a Cystectomy Is Performed
The most common reason for a cystectomy is bladder cancer, specifically cancer that has grown into the muscular layer of the bladder wall or cancer that keeps returning after less invasive treatments. Beyond cancer, the surgery may be needed for structural problems with the urinary system present from birth, neurological conditions that prevent the bladder from functioning, chronic inflammatory diseases affecting the bladder, or bladder damage caused by radiation treatment for other cancers.
Three Types of Cystectomy
The type of surgery depends on the underlying condition and how far disease has progressed.
A radical cystectomy removes the entire bladder along with surrounding tissues and nearby lymph nodes. In men, this typically includes the prostate and seminal vesicles. In women, the standard procedure removes the bladder, urethra, uterus, ovaries, fallopian tubes, and the front wall of the vagina. This is the most common approach for muscle-invasive bladder cancer.
A partial cystectomy removes only the section of bladder containing a tumor while leaving the rest intact. This is rarely performed because it requires the cancer to be small, located in a specific area, and not spread to other parts of the bladder.
A simple cystectomy removes only the bladder itself, without the surrounding reproductive organs or lymph nodes. This option is reserved for non-cancerous conditions where the bladder can no longer function properly.
Open Surgery vs. Robotic-Assisted Surgery
Surgeons perform cystectomies either through a large abdominal incision (open surgery) or through several small incisions using robotic instruments. A large meta-analysis of randomized controlled trials found meaningful differences between the two approaches. Robotic-assisted surgery resulted in about 322 milliliters less blood loss on average and more than halved the likelihood of needing a blood transfusion. Patients who had robotic surgery also had slightly shorter hospital stays and fewer blood clots.
The tradeoff is time in the operating room. Open surgery was roughly 76 minutes shorter. Complication rates were otherwise similar between the two techniques. Not every hospital offers robotic-assisted cystectomy, and the choice often depends on the surgeon’s experience and the complexity of the case.
How Urine Leaves the Body After Surgery
Once the bladder is removed, surgeons construct a new pathway for urine using a segment of your intestine. There are three main options, each with distinct day-to-day implications.
Ileal Conduit
This is the most commonly performed urinary diversion. A short piece of small intestine is fashioned into a tube. One end connects to the ureters (the tubes that carry urine from the kidneys), and the other end is brought through the abdominal wall to create a small opening called a stoma. Urine drains continuously through the stoma into an external collection pouch that sticks to the skin. The pouch needs to be emptied and changed regularly, but the procedure itself is the most straightforward of the three options.
Neobladder
A surgeon creates a new internal bladder from a longer section of small intestine and connects it to both the ureters and the urethra, the natural channel through which urine exits. There is no stoma or external bag. Early on, you need to empty the neobladder frequently, often every one to three hours. Over time, with pelvic floor training and adaptation, most people gain better control. Research shows this option offers a significant advantage in body image and social reintegration, which is why it tends to be recommended for younger patients with good kidney function.
Continent Cutaneous Pouch
This approach uses a portion of the large intestine to form an internal reservoir. A one-way valve made from intestinal tissue prevents urine from leaking. A small stoma on the abdomen serves as an access point, but instead of wearing a bag, you insert a thin catheter through the stoma several times a day to drain the pouch. It offers a middle ground: no external bag, but also no reliance on the urethra.
Preparing for Surgery
Modern cystectomy programs follow Enhanced Recovery After Surgery (ERAS) protocols designed to speed healing and reduce complications. In practical terms, this means you will receive detailed education about stoma care or neobladder management before the operation. You will be encouraged to increase physical activity in the weeks leading up to surgery, and to stop smoking and limit alcohol if applicable. Nutritional optimization is a priority, since better nourishment before surgery leads to faster recovery.
Unlike older protocols that required lengthy bowel preparation and fasting, current guidelines allow solid food up to six hours before surgery and clear fluids up to two hours before. This carbohydrate-loading approach helps maintain energy and reduce post-surgical stress on the body.
Recovery Timeline
Most patients stay in the hospital for four to five days after surgery, though some need additional time before discharge is safe. Walking begins soon after the operation, usually within the first day or two. From there, activity gradually increases. Most people are back to their normal activity level around four weeks after surgery, and the typical return-to-work window is four to six weeks.
The weeks following discharge involve adjusting to your urinary diversion, managing any drains or catheters, and monitoring for complications like urinary tract infections or wound issues. If you received a neobladder, the learning curve for bladder retraining can extend over several months.
Long-Term Quality of Life
Living without a bladder requires permanent adjustments, but most people adapt well over time. The type of urinary diversion has the biggest impact on daily life. Ileal conduits tend to produce the best functional urinary outcomes, meaning fewer leakage problems and infections, but they require wearing an external pouch. Neobladders score higher on body image satisfaction and social confidence, which can matter enormously for psychological well-being.
Sexual function is affected in both men and women. In men, nerve damage during surgery can cause erectile dysfunction. In women, removal of reproductive organs and part of the vaginal wall can alter sensation and comfort during intercourse. These effects vary widely and depend on the extent of surgery and whether nerve-sparing techniques were used.
Long-term medical follow-up is essential regardless of diversion type. Years after surgery, some patients develop kidney function changes, metabolic imbalances from the intestinal tissue absorbing substances from urine, narrowing at the connection between the ureters and the diversion, or urinary tract infections. Regular monitoring catches these issues early, when they are most treatable.
Survival After Radical Cystectomy
For bladder cancer, survival depends heavily on how advanced the cancer is at the time of surgery. When the cancer is still confined within the bladder wall and has not reached the lymph nodes, the five-year progression-free survival rate is about 74%. If the cancer has grown beyond the bladder wall but lymph nodes remain clear, that rate drops to around 50%. When cancer has spread to the lymph nodes, the five-year progression-free survival rate falls to roughly 21%, regardless of how deeply the tumor has penetrated.
Overall five-year survival across all stages is approximately 50%, which underscores why early detection and treatment of bladder cancer significantly improve outcomes. Patients whose cancer is caught while still organ-confined have a five-year overall survival rate closer to 63%.