Surgical removal of the bladder, performed entirely using a robotic surgical system — including the reconstruction of a new way to store and pass urine. For muscle-invasive bladder cancer, this is the definitive surgical treatment.
The urinary reconstruction can be performed completely inside the body using the robot (intracorporeal technique), which has been associated with less blood loss and a quicker recovery. Learn about robotic surgery →
01
Overview of the procedure
Radical cystectomy involves the complete removal of the bladder. In men, this also typically includes the prostate and seminal vesicles; in women, the uterus, ovaries, and anterior vaginal wall may also be removed depending on the extent of disease. Nearby lymph nodes are removed at the same time to help determine whether the cancer has spread.
To better preserve sexual and urinary function without compromising survival, highly selected patients may undergo nerve-sparing robotic cystectomy or organ-sparing robotic cystectomy. In carefully screened men, this involves sparing the prostate and seminal vesicles (or a capsule-sparing approach), while in women, it entails preserving the uterus, ovaries, and vagina. Your procedure will be personalised, and Dr Tan will discuss with you whether you are suitable for these approaches.
Because the bladder is removed, a new way to store and pass urine must be created. Dr Tan will discuss with you the most appropriate option for your individual situation:
Ileal conduit (urostomy): A small segment of bowel is used to create a channel, and urine drains continuously into a bag worn on the abdomen. This is the most straightforward reconstruction.
Neobladder (orthotopic reconstruction): A new bladder reservoir is formed from a section of bowel and connected to the urethra, allowing urine to be passed naturally. This avoids a stoma entirely. This procedure is dependent on patient and cancer factors and may not be appropriate for all patients.
02
Before your procedure
A full pre-operative assessment is essential and will be arranged by the team. This includes blood tests, imaging, cardiac assessment, and anaesthetic review.
Most patients receive neoadjuvant systemic therapy before surgery to reduce the risk of recurrence. This is given for approximately 3 months beforehand and will be coordinated with an oncologist.
If a stoma (urostomy) is a possibility, a specialist stoma nurse will meet with you before the operation to show you what to expect and mark the best site on your abdomen.
An enhanced recovery programme (ERAS) is followed — this includes pre-operative nutrition, early mobilisation, and an evidence-based approach to support your recovery.
Stopping smoking is strongly encouraged. Fast for six hours before surgery; follow any specific pre-admission instructions given by the team.
03
Risks and benefits
Established treatment for muscle-invasive disease
Radical cystectomy is a standard treatment option for long-term cancer control.
Organ-sparing options
Surgery is planned around you, and organ-preservation options and neobladder formation are considered depending on patient and cancer factors.
Quicker recovery
Less blood loss, shorter hospital stay, and faster recovery compared to open cystectomy.
Common
Prolonged recovery
Cystectomy is a major operation. Fatigue and gradual recovery over 4–8 weeks is expected. Most patients return to normal activities within 6–8 weeks.
Common
Sexual function changes
Erection function may be affected in men; vaginal dryness or altered sensation in women. Where oncologically safe, nerve-sparing approaches are used to mitigate this.
Uncommon
Bowel-related complications
As bowel is used in the reconstruction, occasional leaks at the bowel join, prolonged bowel slowness (ileus), or bowel obstruction can occur and may require further management.
Uncommon
Urinary leakage or stricture
Leaks at the urinary connections are uncommon but can occur and are usually managed with catheter drainage. Narrowing of connections (stricture) may require later treatment.
Uncommon
Neobladder-specific issues
Patients with a neobladder may need to learn to urinate by straining (Valsalva manoeuvre). Some require intermittent self-catheterisation. Nocturnal leakage is common initially.
Rare
Major bleeding or thromboembolic events
Blood clots in the legs or lungs (DVT/PE) are a recognised risk of any major pelvic surgery. Blood-thinning injections are given to reduce this risk.
04
Aftercare and recovery
1
Hospital recovery
Most patients spend 4–6 nights in hospital. You will be walking the next day, and the team will guide your diet and fluid intake as bowel function returns.
2
Stoma or neobladder care
Specialist stoma nurses will support you in learning to manage your urostomy bag or neobladder before and after surgery. This support continues in the community after discharge.
3
Activity and return to work
Light activities from 2–3 weeks. Most patients return to work at 6–8 weeks depending on their role. Strenuous activity is restricted for 8–12 weeks.
4
Oncological follow-up
Regular surveillance is essential after cystectomy, including CT scans and blood tests, to check for recurrence. A structured follow-up schedule will be arranged.
Am I eligible for a neobladder, or will I need a stoma?
Should I have chemotherapy before surgery?
Will nerve-sparing be possible in my case?
What will my life be like with a neobladder / urostomy?
What is the chance the cancer has already spread?
Can I meet a stoma nurse before I decide?
Disclaimer
This information is for general education and is not a substitute for personal medical advice.
Content adapted from the British Association of Urological Surgeons (BAUS) and the American Urological Association (AUA) patient information resources.