Surgery for Bladder Cancer

Our urologic surgeons are highly skilled at open surgery and minimally invasive techniques for performing bladder cancer surgery. We develop a treatment plan based on your unique needs with the goal of maintaining as much urinary and sexual function as possible after surgery. To help you recover, we provide follow-up care and support services, including nutrition counseling and physical rehabilitation.

If a tumor has invaded the muscle of the bladder wall, involves multiple sites, or is growing rapidly, the entire bladder may need to be removed, along with nearby lymph nodes. This procedure is called a radical cystectomy and is considered the standard of treatment for cancer that has invaded the bladder muscle. Our highly experienced surgeons have performed more than 2,500 radical cystectomies. We are also experts in using robotic-assisted minimally invasive techniques that provide greater surgical precision, which can result in less pain and a faster recovery.

If your doctor is concerned that cancer may have spread to nearby reproductive organs or structures, he or she may recommend removing them as well. In women, these include the uterus, the organ that carries a baby during pregnancy; the cervix, the disk-shaped tissue at the bottom of the uterus; part of the vagina, the canal of muscular tissue leading from the uterus to the outside of the body; the ovaries, which contain a woman’s eggs; and the fallopian tubes, which carry the eggs to the uterus. 

In men, a radical cystectomy almost always involves removing the prostate, a gland that makes the fluid that becomes semen, which carries sperm. In addition, the seminal vesicles, which also produce fluid to create semen, and part of each vas deferens, the tubes that carry semen to the urethra, which leads to the outside of the body, are also removed.

Whenever possible, our urologic surgeons use nerve-sparing techniques that help you to maintain sexual function after surgery. Our bladder cancer surgeons are highly experienced in nerve-sparing radical cystectomies. Approximately 50 percent of men recover erectile function sufficient for intercourse with the aid of medications 12 to 18 months after surgery. For women, our doctors take care to preserve nerves that affect function in the vagina and external genitals. 

The team also coordinates your care with reproductive medicine specialists at NYU Langone Fertility Center. Our doctors can help you explore a variety of fertility-preserving options, including egg or sperm freezing and storage.

Psychological services are also available to help you manage any concerns related to fertility or sexual function.

In a partial cystectomy, surgeons remove only a portion of the bladder. This procedure may be performed in people who have a solitary tumor that is invading the wall of the bladder.

Doctors consider partial cystectomy when the tumor is not blocking the kidneys and is located in a place where it can be easily removed without compromising the function of the remaining portion of the bladder. The surgeon leaves enough of the bladder so that urination is not affected.

Nearby lymph nodes may also be removed during the procedure because bladder cancer commonly spreads to the lymph nodes first. A pathologist examines the lymph nodes under a microscope for signs of cancer.

If a radical cystectomy is necessary, you may also need urinary tract reconstruction surgery. To perform this procedure, the surgeon uses a segment of the intestine to create a new avenue through which urine can empty from the body. To help you maintain urinary function without a bladder, our surgeons can use one of several reconstructive techniques. 

Our urologic surgeons are highly experienced in performing all types of urinary reconstruction. They are pioneers in minimally invasive reconstructive surgery and have the most experience among specialists in New York City using this innovative technique.

Regardless of the surgical approach, support services are available to people who must adapt to changes in urination after these procedures. 

Ileal Conduit Surgery

During creation of an ileal conduit, the doctor removes a short section of the small intestine, the tube that helps digest food. He or she uses the intestine to create a conduit, or channel, that connects the ureters, tube-like structures that normally carry urine from the kidneys to the bladder, to a surgically created opening in the abdomen called a stoma. 

After the surgery, urine passes from the kidneys, into the ureters, through the conduit, and out the stoma into a plastic receptacle called a urostomy bag or pouch. The pouch is worn on the outside of the body, underneath clothes, where it discreetly collects urine.

The urostomy pouch is emptied three or four times a day. Our nurses and doctors can help you learn how to care for the stoma and use the urostomy pouch.

Neobladder

If a person is healthy enough for more complex surgery, a doctor may be able to create a new bladder, known as a neobladder. People who have a tumor that has not spread to the urethra and who are in good health may be candidates for this surgery. 

To create a neobladder, doctors use a segment of the small intestine that is three to four times longer than the segment needed to create an ileal conduit. The neobladder is attached to the ureters and the urethra, the tube that carries urine to the outside of the body. For this reason, the urethra needs to be intact for this procedure.

A neobladder gives you the ability to urinate without wearing a urostomy pouch. Our doctors and nurses can teach you how adjust to the new sensations that tell you when to urinate. They can also help you learn how to adjust to complications associated with a neobladder, such as urine leakage or the inability to empty the neobladder completely.

Continent Urinary Tract Reconstruction

People who are not candidates for a neobladder surgery but wish to avoid a urostomy pouch may be eligible for continent urinary tract reconstruction, also called catheterizable reservoir surgery. In this procedure, doctors use tissue from the intestines to create a reservoir, which is a small pouch inside the body that collects urine. This pouch is connected to the ureters and to a small stoma in the abdomen. 

The reservoir needs to be emptied every few hours by passing a catheter, a thin, hollow tube, through the stoma. At Perlmutter Cancer Center, surgeons often create the stoma in the belly button to make the opening less visible. Our nurses and doctors can help you learn how to care for the stoma and empty the reservoir. 

Bladder cancer surgery requires that a team of specialists work together to tailor the surgical approach to each person’s needs. People who need surgery to remove the bladder may receive chemotherapy or immunotherapy before the procedure to ensure the most effective treatment. 

Bladder cancer surgery has traditionally been performed with open surgery, which requires making a vertical incision through the lower abdominal and pelvic area. However, for many people, our highly skilled surgeons may choose a minimally invasive, or laparoscopic approach. This allows for the removal of the bladder, as well as reconstruction of the urinary tract, through small keyhole incisions.

Robotic-Assisted Laparoscopic Surgery

Doctors at NYU Langone’s Robotic Surgery Center use a robotic surgical system to perform laparoscopic bladder cancer surgery. The system consists of tiny surgical instruments mounted on three separate robotic arms. A fourth arm contains a camera that creates magnified, high-definition, three-dimensional images on a computer monitor that guides the surgeon during the procedure.

The surgical tools and camera are inserted through small incisions in the abdomen and pelvis. The surgeon controls these instruments and the camera from a console.

Robotic-assisted laparoscopic surgery provides doctors with an up-close and detailed view of the bladder, surrounding organs, lymph nodes, blood vessels, and nerves. This approach may result in less bleeding, less scarring, fewer wound infections, and less postoperative pain than open surgery. It may also lead to a shorter recovery time.

Urologic surgeons at NYU Langone were among the first in the country to offer urinary reconstruction entirely through minimally invasive techniques. Our surgeons have the most experience performing robotic urinary reconstruction in New York City. 

Although this robotic surgery may not be feasible for everyone with bladder cancer, many people are candidates and choose this state-of-the-art technique.