Radical cystectomy is a major surgical procedure involving the complete removal of the urinary bladder, as well as other nearby organs and structures depending on the case. Its primary purpose is to treat bladder cancer that has invaded deeper layers or carries a high risk of spreading (Mayo Clinic, n.d.).
In men, this procedure may involve the removal of the prostate, seminal vesicles, and part of the urethra; in women, it may include the removal of the uterus, ovaries, fallopian tubes, and part of the vagina (Uroviva, n.d.). After bladder removal, a urinary diversion must be created to allow urine to exit the body (Mayo Clinic, n.d.).
The main indications for this surgery are cases of bladder cancer that invade the muscle layer (“muscle-invasive bladder cancer”) or high-grade superficial tumors that do not respond to less invasive treatments (Cancer Research UK, n.d.). In some situations, it is also indicated for palliative purposes when the bladder causes severe symptoms such as pain, bleeding, or recurrent infections (Uroviva, n.d.).
The primary benefit of radical cystectomy is its potential to save the patient’s life by removing the cancer source and preventing its spread (Cancer Research UK, n.d.). However, the physical, emotional, and social challenges are significant. The surgery requires long-term rehabilitation, adjustments to daily routines, and an emotional process of adapting to changes in the body and its function.
Implications for Quality of Life
Radical cystectomy is not only a surgical treatment—it is a profound life change for those who undergo it. After surgery, patients must learn to manage a new way of eliminating urine, either through an ostomy or a neobladder. This change can affect body image and personal autonomy, often leading to feelings of anxiety, shame, or fear (Verywell Health, n.d.).
In terms of sexual and reproductive health, men may experience erectile dysfunction due to the proximity of the nerves responsible for erection to the bladder and prostate, while women may experience changes in vaginal or reproductive function after the removal of pelvic organs (WebMD, n.d.). These effects can impact not only intimacy but also self-esteem and emotional relationships.
Physically, postoperative recovery is demanding: it requires several days of hospitalization, medical monitoring, and progressive rehabilitation. Some individuals may experience complications such as infections, urinary obstructions, loss of sphincter control, or digestive issues (WebMD, n.d.). Additionally, adapting to the urinary diversion involves continuous learning about hygiene, device care, and recognizing warning signs.
Emotionally, many describe a combination of relief (from removing the cancer) and grief (from losing an essential bodily function). Psychological support and health education are essential for better adaptation and social reintegration (Moffitt Cancer Center, n.d.).
Conclusion
Radical cystectomy is one of the most important interventions in the treatment of invasive bladder cancer. It is not only about removing an organ but also about supporting individuals through a comprehensive adaptation process. Recovery of quality of life depends on medical success, psychological support, health education, and social understanding of how this surgery affects identity, sexuality, and autonomy.
References
Brigham and Women’s Hospital. (n.d.). Robotic radical cystectomy.
Cancer Research UK. (n.d.). Removing the bladder (cystectomy).
Mayo Clinic. (n.d.). Bladder removal surgery (cystectomy).
Moffitt Cancer Center. (n.d.). Radical cystectomy for bladder cancer.
Uroviva. (n.d.). Radical cystectomy.
Verywell Health. (n.d.). Bladder cancer surgery: Overview of types and recovery.
WebMD. (n.d.). Cystectomy for bladder cancer.
