Medical expert of the article
New publications
Bladder surgery: methods, care
Last reviewed: 04.07.2025

All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Such a serious surgical intervention as bladder removal is prescribed only in extreme cases - as a rule, in cases of severe oncological diseases of the organ, when chemotherapy and other auxiliary treatment methods do not lead to the patient's recovery.
The first operation to remove the bladder was performed in the 19th century, and since then this method has been successfully used to remove cancerous tumors, papillomatosis, and bladder ectopia. Such an operation is scheduled, except for emergency situations with bleeding.
Indications for the procedure
A bladder removal operation is prescribed when it is necessary to get rid of a pathological neoplasm - a tumor. Removal is a radical way to eliminate a malignant lesion, but in recent years it has been used rarely, since modern medicine has other, more gentle methods in its arsenal.
However, in some cases, bladder removal for cancer is still performed, and it is appropriate in the following situations:
- if the cancerous tumor is in stage T4, but there are no metastases;
- with diffuse papillomatosis;
- if there are several tumors in stage T3;
- in case of changes in the bladder due to tuberculosis or interstitial cystitis.
Some clinics practice bladder removal at the initial stages of oncology development. Indeed, such an approach allows to get rid of the disease for sure and in a short period of time. However, such treatment is carried out only after a personal conversation with the patient and with his consent.
Preparation
Before proceeding with the removal of the bladder, the patient is examined to weigh the degree of risk of complications and to ensure that there are no contraindications to the operation.
Preoperative preparation is carried out in stages:
- The patient's blood is taken for general and biochemical analysis to assess his overall health.
- Blood is also taken to determine glucose levels.
- They evaluate the quality of blood clotting.
- An ultrasound examination of the internal organs and a chest X-ray are performed.
- A cystoscopy procedure followed by a biopsy is performed to determine the type of anesthesia to be used and the surgical technique.
- 6-7 days before the intervention, the patient is recommended to switch to liquid, easily digestible food with a minimum of fiber.
- For 36 hours before the intervention, eating is prohibited: the patient can only drink liquids in the form of tea, compote or juices (dairy products are prohibited).
- 24 hours before the intervention, the patient's intestines are cleansed and diuretics are given.
- On the day of the operation, the patient does not eat.
- Immediately before the surgery, the hair is removed (shaved) from the groin area and abdominal region to eliminate the possibility of infection getting into the wound.
Technique bladder removal
Most often, a laparotomy approach is used to remove the bladder - this is a type of surgery in which healing occurs faster and tissue trauma is minimal. The technique for performing such an operation consists of the following stages:
- The surgeon treats the patient's skin at the site of the proposed punctures (incisions).
- A special catheter is inserted into the urethra, with the help of which urine will be removed during the operation.
- Using an arcuate suprapubic approach, the surgeon exposes and fixes the bladder.
- The doctor opens the bladder cavity and examines it.
- Next, the walls of the bladder are fixed, and in men, the prostate gland is also fixed.
- If the ureters are not brought out and do not move into part of the intestine, then they are cut off at a site of healthy tissue.
- The doctor performs catheterization.
- In men, the vas deferens is tied (this is done carefully so as not to damage the integrity of the intestine).
- The bladder is moved back and up, ligated, the pubovesical and prevesical ligaments are crossed, as well as the urethra (in men, this is done especially carefully, since the prostate gland located nearby can be affected).
- The doctor removes the bladder, tampons the bleeding sites, sutures the vessels, and installs drainage.
- Through an external opening in the abdominal wall, the surgeon inserts a catheter-reservoir into the urethra and forms a new bladder.
- The surgeon sutures the wound (layer by layer), leaving space for drainage, and applies a sterile bandage.
Methods of bladder removal
Removal of the bladder performed using laparoscopy is easier for patients to tolerate, and the wound after such an intervention heals faster.
As for the method of removing and replacing the bladder, there are several methods:
If the organ is modeled from a section of the small intestine, then a section of approximately 600 mm in length is used: a volumetric formation similar to the bladder is formed from it, which is connected to the ureter and urinary duct. This type of surgery is considered the most acceptable, since the patient will then be able to empty the bladder naturally. But this surgery is not indicated for all patients. For example, if the patient has tumors of the urethra or intestine, or suffers from acute enterocolitis, then the intestine cannot be used for transplantation.
If the outlet for urine drainage is brought out into the area of the anterior abdominal wall, then a new intestinal container is simultaneously created, which the patient will have to periodically empty using a special catheter.
If the ureter is connected to the small intestine, the intestinal loop can be brought out, and the urine will be collected in a suspended reservoir. The second option for such a connection is the removal of the ureter mouth into the intestinal cavity: in this case, the patient's urine will be excreted from the body through the rectum, simultaneously with feces.
Features of bladder removal
Removal of the bladder in men has some peculiarities. Thus, given the specific anatomical structure of the genitourinary system in the male body, catheterization must be carried out very carefully and accurately. The fact is that if the medical specialist lacks experience, problems may arise with the insertion of the catheter, due to the fact that the male urethra is relatively long (23-25 cm), narrow and has two natural constrictions. As a result, the catheter does not pass freely.
Particular care should be taken when inserting a metallized catheter: manipulations with such an instrument are difficult, and if used carelessly, the mucous membrane of the urinary tract can easily be damaged. This can lead to bleeding and even perforation of the walls of the urinary canal. Given this, it is preferable to use a soft disposable catheter.
In addition, during radical removal of the bladder in men, the nearest lymph nodes, prostate and seminal vesicles are also removed.
Removal of the bladder in women is combined with resection of the urethra, ovaries, uterus and anterior vaginal wall. The surgeon has to remove other organs because in most cases cancer cells grow into nearby organs: the prostate gland in men, the uterus and appendages in women.
Removal of the uterus and bladder is a forced measure that allows us to give a relative guarantee that the malignant process will not recur - that is, it will not relapse. Unfortunately, cancer often spreads and grows quite quickly, and malignancy occurs even in those organs that seem healthy during diagnosis.
But the removal of the kidney and bladder at the same time is considered a rather rare operation, although the entire urinary system may suffer from kidney disease. If the tumor process (usually transitional cell cancer) affects the renal pelvis and ureter, it is not at all necessary that it will spread to the bladder. According to statistics, this occurs in only 1% of all cases of malignant lesions of the kidneys and upper urinary tract.
Many patients ask themselves this question: if the tumor is small and does not grow into neighboring organs, is it possible to remove part of the bladder, rather than remove it entirely? Indeed, such operations are performed, and they are called simple, or non-radical. However, they are done very rarely, only to some patients diagnosed with superficial bladder cancer. Partial removal of the bladder often leads to relapses - repeated developments of the cancer process, and the operation itself is classified as complex and can be accompanied by various unforeseen circumstances.
One of the options for partial resection is the removal of the bladder neck - this is an endoscopic procedure that is performed transurethrally - through the urethra. This operation is performed in case of inflammation of the neck of the organ, in the presence of cicatricial changes in the tissues. A special loop heated by electric current to a high temperature is used for the procedure. Using the loop, the surgeon cuts off the affected tissues and simultaneously cauterizes the damaged vessels, stopping the bleeding.
If the bladder neck is affected by a cancerous tumor, then in the vast majority of cases the doctor will not consider the possibility of partial removal of the organ. Radical resection is considered more acceptable in terms of complete cure from oncological pathology.
Contraindications to the procedure
Not everyone can have their bladder removed. This operation is prohibited:
- if the patient is in serious condition;
- if the patient has serious cardiovascular diseases that make general anesthesia impossible;
- if the patient suffers from diseases that may subsequently lead to complications - during or after surgery;
- in case of blood clotting disorders that may lead to the development of bleeding or thrombosis;
- for infectious diseases in the acute stage.
[ 14 ]
Consequences after the procedure
The main consequence of bladder removal is considered to be the problem of urinary fluid excretion. Doctors are forced to create bypasses for urinary outflow in the body, as well as to consider the possibility of installing containers for its collection.
The routes of urine excretion may vary depending on the characteristics of the disease and the type of surgery, as well as many other reasons.
Only those patients who had a small intestine transplanted to replace the bladder are free of such problems. The intestinal element, acting as a bladder, completely restores the person's ability to excrete urine naturally.
However, it is not always possible to use part of the intestine: often the container for collecting urine is brought out, restricting the free flow of liquid with a special valve. The patient must periodically catheterize the outlet and empty the reservoir.
In some cases, the ureters themselves may be brought out: after such an operation, the patient is forced to use special urine collectors, which are attached to the skin directly near the outlet.
Complications after the procedure
Most of the above methods of removing urine from the body are not perfect, but they still help the patient solve the problem with urination. Possible postoperative complications include bleeding, infection - however, in a hospital setting, such difficulties are rare.
Much more often, the patient encounters other complications while already at home:
- the ureters can become clogged;
- urinary incontinence may occur due to blockage or defect of the valve;
- inflammation of the outlet tract may occur;
- the passages can become clogged with purulent discharge or mucus;
- Tubes and catheters can slip out and even leak.
The doctor will tell you how to solve such problems. Relatives living with the operated person must have considerable patience and optimism to support the patient and help him at the first need.
Care after the procedure
The attending physician will inform the patient about the specifics of postoperative care. Immediately after the operation, the patient is placed in the intensive care unit, and after stabilization of the condition - in the urology department. Antibiotic therapy will be administered for approximately 3 weeks against the background of taking analgesics.
Drains installed during surgery are removed within the first few days. The patient can be discharged home after 10 days.
At home, the patient should independently monitor his/her well-being. It is necessary to immediately inform the doctor:
- if the temperature has risen;
- if postoperative pain increases, redness or bleeding from the wound appears;
- if vomiting occurs periodically;
- if after taking painkillers there is no relief;
- if the smell of urine has changed, pus has appeared from the catheter;
- if you experience pain behind the breastbone, cough with difficulty breathing.
If you see a doctor in time, you can avoid many complications.
Life After Bladder Removal
After the patient's bladder is removed and he is discharged from the hospital, his life practically returns to its previous course. The only thing that changes is the urination process. From time to time, the patient will have to change the urine bag, empty the container with urine, and treat the place where the intestinal loop or container is brought out.
If a patient has a bladder-like structure formed from the intestinal wall during the operation, the life of the operated person will be much more comfortable. During the first 12-15 days, urine will be collected in a special urine collector until the "new" bladder and urinary system heal. Then the doctor will wash the bladder with a disinfectant solution, remove the drainage tubes, catheters and stitches. From this point on, the patient can actually return to his usual way of life.
Diet after bladder removal
Nutrition after bladder removal does not change too dramatically. The patient is allowed to eat food on the second or third day after the intervention - this depends on the degree of intestinal damage during the operation.
Doctors advise to eliminate fried, spicy and fatty foods from the diet. Meals should contain protein, as well as enough vitamins and microelements for the fastest possible recovery of the body. Alcoholic drinks, smoking, large amounts of salt and spices are prohibited.
What can you eat after bladder removal?
During the first 2-3 days after resection, as a rule, the patient is allowed to take only easily digestible pureed food: broths, light soups, liquid porridges - in small quantities. Of the drinks allowed: weak tea, compote, jelly.
Then the menu is gradually expanded. To improve bowel function, fiber and fermented milk products are gradually introduced into the diet. Vegetable side dishes, baked fruits, porridges (possibly with dried fruits), lean meat and fish are welcomed. For dessert, you can prepare cottage cheese, fruits, yogurts, jelly.
The amount of liquid consumed per day should be discussed with your doctor.
Sex after bladder removal
Doctors recommend abstaining from sexual intercourse for the first 1-1.5 months after surgery. However, if all doctor's recommendations are followed, sexual life can be resumed in the future.
It is important to pay attention to the following points:
- sometimes during surgery, nerve endings may be affected, which can lead to loss of erectile function in men;
- Some patients experience dry ejaculation after bladder removal, which does not indicate loss of orgasm;
- In women, after surgery, the vagina may become narrower, which will create certain difficulties during sexual intercourse and will also affect the ability to experience orgasm.
Each case of bladder removal is unique, so the possibility of having sex should be considered individually for each patient. In such a situation, you cannot do without consulting your doctor.
Disability after bladder removal
A person may be assigned disability after removal of the bladder:
- in case of moderate limitation of life activity or significantly limited employment opportunities;
- in case of pronounced and sharply expressed limitation of life activity.
When submitting documents for registration of disability, the patient must provide the results of general blood and urine tests, as well as information on histological and cystoscopic examination, which allows determining the extent of the malignant process.
The third disability group is assigned to individuals with moderate limitations of life activities and a minor degree of urinary incontinence.
The second group is assigned in the presence of a postoperative urinary fistula in the anterior abdominal wall, as well as in case of ineffective radical treatment with tumor recurrence.
[ 23 ]
Life expectancy
The prognosis for a person who has undergone bladder removal surgery depends on whether and to what extent the intervention was performed. For most patients, this prognosis is considered favorable. The life expectancy of patients who have undergone surgery can be decades, provided that all doctor's recommendations are followed.