When it is needed
Muscle-invasive bladder cancer, high-grade non-invasive disease that keeps recurring despite BCG, and some cases where the bladder has been destroyed by disease. Neoadjuvant chemotherapy before surgery improves survival in muscle-invasive cancer and is planned jointly with medical oncology.
The diversion choice
Once the bladder is removed, urine needs a new route out. Both options work well; they suit different people, and the choice deserves an unhurried conversation with the stoma nurse involved.
- Ileal conduit: urine drains through a short bowel segment into a stoma bag — simpler, shorter surgery, reliable
- Neobladder: a bladder built from bowel and joined to the urethra — no external bag, but needs motivation, training and acceptance of possible night-time leakage
- Continent cutaneous pouch: catheterised through a small abdominal opening, in selected cases
Recovery
Typically seven to ten days in hospital and six to eight weeks to full recovery, with enhanced recovery protocols reducing both. Stoma training starts in hospital and continues at home. Vitamin B12, kidney function and electrolytes are monitored long term because a bowel segment is now handling urine.
Radical Cystectomy — common questions
Can the bladder be preserved instead?
In selected patients, chemotherapy combined with radiotherapy after a complete TURBT is an alternative. Suitability depends on tumour size, site and whether hydronephrosis is present.
Is life normal with a stoma?
Most patients return to work, travel and exercise. Modern appliances are discreet, and proper training from a stoma nurse makes the difference.
Will I need chemotherapy?
Neoadjuvant chemotherapy before surgery is standard for muscle-invasive disease. Adjuvant treatment depends on the final pathology.
How long is the surgery?
Usually four to six hours including the diversion, depending on the type of reconstruction.
Reviewed by Dr. Kinjal Banerjee, MBBS, MS (General Surgery), DNB (Urology) — Urologist, Renal Transplant & Robotic Surgeon, Faridabad. This page explains radical cystectomy in general terms; your own treatment plan depends on your reports and examination.