Life After Bladder Cancer Surgery
- Surgery to remove the bladder is a common treatment for bladder cancer, and the one most likely to lead to a cure.
- Your surgeon will perform a urinary diversion to allow you to urinate after your bladder is removed.
- Urinary diversion can lead to some changes in your lifestyle, but it shouldn’t stop you from doing most of the things you enjoy.
Having urinary diversion surgery will let you go back to a normal, active lifestyle. But you will need to learn how to care for your new system.
Urinary Diversion: Two Methods
There are two ways for surgeons to perform a urinary diversion. “During the surgery, the surgeon will take a portion of the small intestine and fashion it either into what is called a conduit or a neobladder,” Dr. Arjun Balar, assistant professor of medicine and directory of the Genitourinary Cancer Program at the NYU Perlmutter Cancer Center, tells SurvivorNet.
An ileal conduit is the most common way to do this. The surgeon removes a piece of your small intestine and then reconnects the rest so that you can poop normally again. One end of the removed intestine segment attaches to an opening called a stoma in your abdominal wall. The other end connects to your ureters, which drain urine from your kidneys. A urostomy bag attached to the stoma collects urine.
“The kidneys can make urine like they always do. That urine travels down the ureters, through the piece of intestine, and then out into a plastic bag that the patient wears,” Dr. Shah explains.
To make a neobladder, the surgeon uses a section of small intestine to create a pouch. They then place that pouch into the area where your bladder once sat and connect it to your urethra and ureters. “So the urine still goes from the kidneys down the ureters into this neobladder, and then out the urethra,” Dr. Shah explains. You can urinate much the way you used to do, but with a few adjustments.
Learning How to Urinate Again
Expect a learning curve after neobladder surgery. “What I tell patients is that the sensation of urination will be somewhat different starting out,” Dr. Balar says.
For the first few weeks after surgery, you’ll likely have a catheter. This long flexible tube goes up your urethra into your neobladder to drain urine. It can take several months before you’re fully able to urinate on your own again.
With a conduit, your medical team will teach you how to care for your stoma and change the collection bag. A specialist called an enterostomal therapist can also give you pointers. “They see you before you have surgery, so you can actually hold the bag and see what it looks like, and see what it’s going to look like on your belly,” Dr. Shah says. After your surgery, they’ll continue to help you get used to your bag.
Adjusting to Life After Urinary Diversion
Having your bladder removed could cure your cancer. But living without a bladder, whether you have a conduit or a neobladder, is a big change.
A neobladder will let you urinate without a bag, but it also some limitations. For one thing, you’re more likely to have incontinence. That means you’ll leak urine.
“Usually it’s in men, and usually it’s at night, when they sleep. So we call it nocturnal incontinence,” Dr. Shah says.
You can regain control over urination by:
- Doing pelvic muscle exercises
- Setting an alarm to use the bathroom
- Seeing your doctor for regular progress checks
A small percentage of patients with a neobladder will need to perform intermittent self-catheterizations over the long-term to help urine exit the neobladder.
In the case of a conduit, having a bag attached to your body that constantly collects urine might seem frightening. “A lot of people, when they think about this, they’re very turned off. ‘Oh my goodness, I’m going to have to wear a bag for the rest of my life…I can’t leave the house anymore. I can’t play golf,’” Dr. Shah says. “And the truth is, most patients can go back to doing everything they used to do just fine.”
The one time the bag may be noticeable is if you wear a bathing suit or take your shirt off. “But for everything else, for what most of my patients do — patients who like to garden and hike and hunt and swim and boat — they’re able to go back to doing all of that just fine.”
Sex After Diversion Surgery
One question that Dr. Shah’s patients often ask him is, “Can I still have sex after surgery?” He says the procedure can rob men of their ability to have erections. Women may be left with a smaller vagina that makes sex difficult — but not impossible.
“What I tell my patients is that, if having a sex life is important to you, once we’ve managed the cancer and the dust has settled from that, there are different things that we can do to let you have intercourse again,” he says.