What is a Radical Cystectomy?
A radical cystectomy is a major surgical operation to remove the entire bladder. It is most commonly performed to treat muscle-invasive bladder cancer or high-risk bladder cancer that cannot be controlled with other treatments.
Because the bladder stores urine, a new way for urine to leave the body must be created. This is called a urinary diversion.
The two most common types of urinary diversion are:
Ileal conduit (urostomy)
Orthotopic neobladder
Your surgeon will discuss which option may be most suitable for you.
Radical Cystectomy and Urinary Diversion
What Happens During Radical Cystectomy?
During the operation:
In Men
The following structures are usually removed:
Bladder
Prostate
Seminal vesicles
Nearby lymph nodes
In Women
The following structures may be removed:
Bladder
Uterus
Part of the vagina
Nearby lymph nodes
Sometimes the ovaries
The surgery is performed under general anaesthetic and may be done using open surgery or robotic-assisted techniques.
The operation typically takes 4–6 hours.
Urinary Diversion Options
Because the bladder is removed, urine must be redirected using a section of the intestine.
Two common options are ileal conduit formation and neobladder formation.
Ileal Conduit (Urostomy)
What is an Ileal Conduit?
An ileal conduit is the most common and simplest form of urinary diversion.
A small segment of the small intestine (ileum) is used to create a channel that allows urine to pass from the kidneys to the outside of the body.
The ureters (tubes from the kidneys) are attached to this intestinal segment, which is then brought to the surface of the abdomen to form a stoma.
Urine drains continuously into a urostomy bag attached to the skin.
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Living with an Ileal Conduit
Urine drains into a collection bag attached over the stoma.
The bag is emptied regularly during the day.
The appliance is usually changed every 3–5 days.
Specialist stoma nurses provide education and support to help patients manage the stoma confidently.
Many people return to normal daily activities, travel, and exercise after recovery.
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Advantages of Ileal Conduit
Shorter and technically simpler operation
Lower risk of complications compared with other diversions
Suitable for many patients
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Possible Disadvantages
Requires wearing a urostomy bag
Risk of skin irritation around the stoma
Stoma care is required long term
Orthotopic Neobladder
What is a Neobladder?
A neobladder is an internal urinary reservoir created using a section of the small intestine.
This new bladder is connected to the urethra, allowing urine to pass in a way similar to normal urination.
Patients pass urine through the urethra rather than through a stoma.
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How the Neobladder Works
Because the neobladder is made from intestine, it does not function exactly like a normal bladder.
Patients usually need to:
Empty the neobladder by relaxing the pelvic floor and gently straining
Urinate at regular intervals
Some patients may occasionally need to use a catheter to empty the bladder fully.
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Advantages of Neobladder
No external stoma or bag
Urination occurs through the urethra
More natural body image for some patients
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Possible Disadvantages
Longer and more complex surgery
Risk of urinary leakage (incontinence), particularly at night
Some patients require intermittent catheterisation
Not suitable for all patients
Recovery After Surgery
After radical cystectomy:
Hospital stay is typically 7–10 days
Full recovery may take 6–8 weeks
During recovery you may experience:
Fatigue
Temporary bowel changes
Adjustment to the urinary diversion
You will receive support from:
Surgeons
Specialist nurses
Stoma nurses (if an ileal conduit is performed)
Possible Risks and Complications
As with any major surgery, risks include:
Bleeding
Infection
Blood clots
Bowel obstruction
Urine leakage from surgical connections
Problems with the urinary diversion
Sexual dysfunction
Hernia near the stoma (ileal conduit)
Your surgical team will discuss these risks with you.
Follow-Up After Surgery
Regular follow-up is important to monitor recovery and check for cancer recurrence.
Follow-up may include:
Clinical examinations
Blood tests
Imaging scans
Monitoring kidney function
Living After Bladder Removal
Many patients return to a full and active life after radical cystectomy.
Support is available to help you adjust to life with a urinary diversion. Your healthcare team will provide education, guidance, and ongoing care.
