Urinary diversion
If your bladder is removed during a radical cystectomy, an alternative way of passing urine out of your kidneys will need to be found.
There are a number of different treatment options, which are described below. In some cases, you may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone.
Your doctor will be able to provide you with information about which option (or options) are suitable for you.
Urostomy
A urostomy is the most common type of urinary diversion operation. During the operation, the surgeon will make a hole in your abdominal wall. This hole is known as a stoma.
A small section of your small bowel will be removed and connected to your ureters (the two tubes which, in normal circumstances, carry urine out of the kidneys).
The other end of the small bowel will be connected to your stoma. A flat, water-proof pouch is then connected to the stoma to collect the urine.
After the operation, you will be introduced to a stoma nurse. The nurse will teach you how to care for your stoma and how and when to change the collection pouch.
Most people need to empty their pouch the same number of times a day that they would usually pass urine.
Continent urinary diversion
A continent urinary diversion is a similar sort of operation to an urostomy, except that you will not be required to use a collection pouch.
A section of your bowel will be used to create an internal pouch that is used to store your urine. The pouch will then be connected to your ureters at one end, and to a stoma that is made in your abdominal wall at the other end.
You can empty the pouch by inserting a catheter (a thin, flexible tube) into the stoma and use it to drain away the urine. Most people need to empty their pouch about 4-5 times a day.
Bladder reconstruction
In some cases, it may be possible to create a ‘new bladder’, known as a neobladder. This can be done by removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra at one end and your ureters at the other end.
Bladder reconstruction is not a suitable treatment for everyone. For example, it cannot be used if the cancer has spread to your urethra because your urethra will have to be removed during surgery.
You will be taught how to empty your neobladder by relaxing the muscles in your pelvis, while at the same time tightening the muscles in your abdomen.
Your neobladder will not contain the same types of nerve endings as a real bladder so you will not get that distinctive sensation that tells you that you need to pass urine. Some people experience a feeling of fullness inside their abdomen while other people have reported that they feel like they need to pass wind.
Due to the loss of normal nerve function, around 20-30% of people with a neobladder will experience some episodes of incontinence (the involuntary passing of urine) which usually occur during the night when they are sleeping.
It may be useful to empty your neobladder at set times each day, and then once more before you go to sleep because this may help to prevent incontinence.
Erectile dysfunction
You should contact your doctor if you lose the ability to obtain and/or maintain an erection. It may be possible for you to be treated with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis.
The most commonly used PDE5 is sildenafil (Viagra). However, other PDE5s are available if sildenafil is not effective.
An alternative to PDE5s is a device called a vacuum pump. A vacuum pump is a simple tube that is connected to a pump. You place your penis in the tube and then pump out all the air. This creates a vacuum which causes the blood to rush to your penis. You then place a rubber ring around the base of your penis, which keeps the blood in place allowing you to maintain an erection for around 30 minutes.
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