A cystoprostatectomy is a surgical procedure that removes the bladder and prostate gland together, typically as treatment for bladder cancer that has grown into the muscle wall. When performed as a cancer operation, it’s called a radical cystoprostatectomy, and it also removes surrounding tissues, nearby lymph nodes, and the seminal vesicles. It is considered the standard treatment for muscle-invasive bladder cancer and is one of the most complex urological surgeries performed today.
Why the Surgery Is Performed
The primary reason for a cystoprostatectomy is muscle-invasive bladder cancer, meaning the tumor has grown beyond the inner lining of the bladder into the muscle layer beneath it. At that point, less aggressive treatments like scraping out the tumor through a scope are no longer sufficient. The procedure is also used for high-risk non-muscle-invasive bladder cancer that keeps coming back despite repeated treatments, or that shows aggressive features under the microscope suggesting it will progress.
In most cases, chemotherapy is given before or after surgery to improve outcomes. The operation itself includes removal of pelvic lymph nodes to check whether cancer has spread and to reduce the chance of recurrence.
What Gets Removed
In men, a radical cystoprostatectomy removes the bladder, prostate, seminal vesicles, the ends of both ureters (the tubes connecting the kidneys to the bladder), and surrounding fatty tissue along with pelvic lymph nodes. The urethra may also be removed depending on whether cancer is found near it.
Women undergo a related but different procedure called a radical cystectomy with anterior pelvic exenteration. This removes the bladder, uterus, fallopian tubes, ovaries, the front wall of the vagina, and the urethra. The core goal is the same: clear all cancerous tissue with wide margins to prevent recurrence.
How Urine Is Rerouted Afterward
Because the bladder is gone, surgeons must create a new path for urine to leave the body. This is called a urinary diversion, and there are three main options. The choice depends on the extent of cancer, your overall health, body shape, and personal preference.
- Ileal conduit: The simplest and most common option. A short segment of small intestine is used as a tube connecting the ureters to an opening (stoma) on the abdomen. Urine drains continuously into an external bag worn against the skin. It requires the least maintenance but means wearing a collection bag at all times.
- Neobladder: A new bladder-shaped pouch is constructed from a section of intestine and connected to the urethra in its normal position. You urinate by relaxing and gently bearing down rather than by the normal muscle squeeze, and the sensation of “needing to go” is different. There’s no external bag, but nighttime leakage is common, and some people need a catheter occasionally.
- Continent cutaneous diversion: An internal pouch is made from bowel and connected to a small stoma on the abdomen. Unlike the ileal conduit, there’s no external bag. Instead, you insert a thin catheter through the stoma four to six times a day to drain the pouch. This option requires commitment to a regular self-catheterization schedule.
Open Surgery vs. Robotic Surgery
Cystoprostatectomy can be performed through a large abdominal incision (open surgery) or with robotic assistance through several small incisions. A meta-analysis of randomized controlled trials found that robotic surgery resulted in about 322 milliliters less blood loss and fewer blood transfusions compared to open surgery. Patients who had robotic surgery also had slightly shorter hospital stays. Open surgery, however, was about 76 minutes faster in the operating room. Complication rates were similar between the two approaches, and cancer outcomes appear equivalent based on current data.
Recovery After Surgery
This is major surgery with a substantial recovery period. Most patients spend roughly one to two weeks in the hospital, though enhanced recovery programs at some centers aim to shorten that. The earliest days focus on managing pain, getting out of bed, and waiting for the bowels to wake back up.
One of the most common complications is postoperative ileus, a temporary shutdown of normal bowel activity. Depending on how it’s defined, this affects roughly 20 to 27% of patients. Symptoms include nausea, bloating, and an inability to tolerate food. It typically resolves on its own but can extend the hospital stay. Overall major complication rates range from about 5 to 26%, which reflects the complexity of the operation.
Full recovery at home takes several months. Most people need six to eight weeks before returning to normal daily activities, and it can take longer before energy levels feel close to baseline. During this time, you’ll be adjusting to whichever urinary diversion was created, learning stoma care or new voiding techniques, and gradually rebuilding strength.
Effects on Sexual Function
Standard radical cystoprostatectomy removes the nerve bundles that run alongside the prostate and control erections, causing severe erectile dysfunction. For men whose cancer location allows it, surgeons can perform a nerve-sparing version that carefully preserves these bundles.
Cleveland Clinic’s experience with nerve-sparing cystectomy has shown encouraging results. By about six months after surgery, most patients had only mild erectile dysfunction, and their scores on a validated 25-point erectile function questionnaire returned to within three points of their preoperative baseline. Importantly, the nerve-sparing approach did not compromise cancer clearance: none of the eligible patients had cancer cells at the surgical margins. Not everyone is a candidate for nerve sparing, though. It depends on the tumor’s size and location relative to the prostate.
Beyond erections, body image can be a significant quality-of-life concern, particularly for people who have a stoma. Urinary function changes are universal since the original bladder is gone, and adjusting to a new way of managing urine takes time and patience.
Survival Rates
For patients whose bladder cancer has invaded the muscle wall at the time of diagnosis, the five-year overall survival rate after radical cystectomy is approximately 46%, with progression-free survival around 49%. These numbers improve considerably for cancer caught at earlier stages and worsen for cancer that has already spread to lymph nodes or distant organs. Survival outcomes have been gradually improving with the addition of chemotherapy before surgery and better patient selection.
Follow-Up After Surgery
Cancer surveillance continues for at least five years after surgery. CT scans of the abdomen and chest are the primary tool for detecting recurrence. Some centers perform these scans every six months, while others do them annually, often adjusting the schedule based on how aggressive the original cancer was. Lower-risk patients may alternate CT scans with ultrasound and chest X-rays to reduce radiation exposure. Blood work and urine tests are checked at every visit.
If the urethra was left in place, periodic scope examinations of the remaining urethra may be performed to watch for new cancer developing there. Higher-risk patients may also undergo PET scans for more sensitive detection of recurrence. This monitoring schedule gradually becomes less frequent after the first few years if no cancer is found.