What Patients With Cancer Need to Know About Bladder Removal Surgery

CURE spoke with experts about radical cystectomy for patients with bladder cancer: © stock.adobe.com.

For patients with bladder cancer, surgical removal of the bladder – a procedure known as a radical cystectomy – is a common treatment path, experts explained in interviews with CURE.

“I generally like to perform bladder removal using a laparoscopic robot-assisted approach. This means we make small incisions in the abdominal wall and insert ports. We then put instruments through the ports and dock the robot to them. This allows me to get really deep into the pelvis and see everything. When you do these surgeries as an open procedure, it's very hard to get both hands in the pelvis and perform a very fine surgery, at least for me. After the bladder removal, we often remove lymph nodes as well to make sure the cancer hasn't spread to them. Then, we create some sort of urinary diversion, a way to reroute the urine so that it can leave the body,” Dr. Janet Kukreja, a urologic oncologist, explained in an interview with CURE.

Kukreja serves as the director of Urologic Oncology at the University of Colorado Anschutz Medical Campus, UC Health,

Among Kukreja’s patients is Deion Sanders, a star football player who now works as the football coach at the University of Colorado. Sanders, 57, made news in July when he announced that had received a diagnosis of bladder cancer, but his care team considered him cured after the surgical removal of his bladder.

Radical cystectomy entails removal of the full bladder as well as the reconstruction of a portion of the anatomy where ureters, or tubes that connect the kidney to the bladder, are hooked up to either an ileal conduit — a piece of bowel brought up to the skin — or an artificial bladder referred to as a neobladder, Dr. Nitin Yerramexplained. Yerram is co-director of urologic oncology at John Theurer Cancer Center, part of Hackensack Meridian Health in New Jersey.

The surgery, Yerram said, can take four to six hours, after which patients are hospitalized for three to seven days, with a recovery period of six to eight weeks; patients will face potential fatigue and dehydration in the interim period.

“Everybody recovers differently,” said Kukreja. “I have some patients that are chomping at the bit to get back to mountain biking, hiking, or whatever they do. I also have some people where it takes a little bit longer. Pretty much everybody, by six to eight weeks, is ready to go. However, for some patients, it really does just take a little extra time. Some people, after two weeks, they're like, ‘Can I go back to work?’ And I'm like, ‘Wait, what do you do for work?’”

“It's always a daunting journey to face in bladder cancer,” Yerram explained. “Bladder cancer is extremely aggressive and has a high rate of mortality. That said, the therapies and surgeries have improved over the last 15 to 20 years, so I think it's important to be evaluated by a physician or a surgeon who does this day in and day out. This is because there's a lot more options that patients have now than they had 15, 20 years ago. Just in the last probably five years, there's been probably a quadrupling of number of options that patients have for bladder cancer in terms of advanced therapeutics.

“So it's really important to know that although it may seem grim, the reality is there's a lot of options; patients now have a better chance of fighting this cancer now than they've ever had.”

In the United States, there will be approximately 84,870 newly diagnosed cases of bladder cancer — about 65,080 in men and 19,790 in women — and approximately 17,420 deaths from the disease, according to estimates from the American Cancer Society, which stated that bladder cancer is the 10th leading cause of cancer death in the United States.

“There's so much out there, and one treatment that is right for one person is not necessarily right for the next,” said Kukreja. “You have to be really thoughtful about what's right for you. And I recommend keeping an open mind. There's a very broad spectrum of things that we can do, and people that are at different places in their life may not want a bladder removal. Some people may not need a bladder removal. You just have to keep an open mind that every cancer is a different cancer. This is where that personalized medicine comes into play. You need a personalized treatment plan for you, but keep an open mind.”

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