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Some cancer survivors have had an operation to remove their
bladder (cystectomy) as part of their cancer treatment or because of treatment
complications. Here’s what you need to know to recognize the signs and symptoms
urinary problems that may occur after cystectomy.
Cystectomy is an operation to remove the urinary bladder.
After the bladder is removed a new passage is created for urine to leave the
body. The three main procedures used are called ileal conduit, cutaneous
continent diversion, and orthotopic neobladder.
Ileal Conduit or Urostomy
A loop of small intestine is removed and used as a pipeline through
which urine flows from the ureters to an opening on the outside the body
(stoma). There it is collected in a pouch.
Cutaneous Continent Diversion
A small pouch made from intestine is placed inside of the
abdomen to collect urine from the ureters (ileal pouch). The appendix or
another piece of intestine is used to create an extension from the pouch to an
opening on the surface of the skin. Urine is removed several times a day from
the pouch by inserting a tube (catheter) into the opening.
A new bladder is made from bowel and connected directly to
the urethra. Some people are able to urinate naturally. Others need to use a
If you have an ileal conduit or ileal pouch, urine may leak around
the opening on the surface of your skin and cause irritation or infection. Scar
tissue may form around the ureters or the conduit and block the flow of urine
from the kidneys. Back flow of urine into the kidneys may also occur, which
raises risk for urinary tract infection and kidney stones.
If you have a neobladder, you might not be able to control
when you urinate. Muscle retraining can help, though. If you have ongoing urine
leakage, testing of the neobladder and urethra can help decide next steps.
People who have had surgery that involves the small
intestine sometimes have levels of chemicals and fats in the blood that are not
normal. This can cause diarrhea, kidney stones, and low levels of vitamin B12.
Cystectomy may also increase the risk for sexual problems.
Surgery and medicine may be helpful.
If you had a cystectomy, you’ll need life-long close
follow-up by a doctor who specializes in the urinary tract (urologist). An
enterostomal nurse (“ET nurse”) can give you advice about skin care and
supplies. The nurse can also help resolve any problems
If you had bladder surgery that involved your small
intestine, you should have a blood test every year to check your vitamin B12
level starting 5 years after your surgery. This can be part of your annual
long-term follow-up visit.
Call your doctor if you have these symptoms:
Call your doctor right away if you have vomiting or
abdominal pain. These symptoms might signal a blockage in your bowel from scar
Go to the emergency room if you perform self-catheterization
and you have trouble inserting the catheter. This is an emergency that needs to
be evaluated right away in case your pouch might rupture.