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Overview
What is Bladder Cancer?
The bladder is the balloon-like organ in the lower part of the belly that stores urine. Bladder cancer happens when cells in the bladder start growing out of control.
What Causes Bladder Cancer?
The exact cause is not always known. It is often linked to damage to bladder cells, usually due to harmful substances like tobacco.
Who is at Risk?
- You smoke or have smoked in the past
- You are over 50 years of age
- You are a male
- You are exposed to certain chemicals at work (factories, dyes or rubber industries)
- You have a history of repeated urine infections or long-term bladder irritation
- You have had radiation therapy or certain medicines in the past
- You have a family history of bladder cancer
Symptoms of Bladder Cancer
- Blood in urine (rusty to bright red)
- Burning or pain while passing urine
- Frequent urge to pass urine
- Frequent urination at night
- Lower back pain
- Bone pain
- Swelling in the feet
- Weight loss without any reason
- Tiredness
How is it Diagnosed?
- Pelvic examination
- Urine tests
- Blood tests
- CT scan (scan to see inside the body)
- Intravenous pyelogram (X-ray imaging using a dye)
- Cystoscopy (camera test to look inside the bladder)
- Biopsy (testing a small tissue sample)
How is this Condition Managed?
- Surgery (main treatment — partial or radical open/laparoscopic cystectomy, robotic cystoprostatectomy)
- Chemotherapy (drugs to kill or stop the growth of cancer cells)
- Radiation therapy (high-energy radiation to halt cancer cell growth)
- Immunotherapy (helping the immune system fight cancer)
Overview of Cystoprostatectomy
What is it?
Cystoprostatectomy is an operation to remove the bladder, prostate gland, semen-producing glands and nearby lymph nodes. A new path for urine to pass out of the body is created.
Why is this Procedure Done?
A doctor may recommend this procedure when:
- Bladder cancer has spread into the bladder muscle
- Bladder cancer occupies a large part of the bladder
- High-risk cancer not responding to other treatments
Types of Surgery
Open surgery: Large cut on the belly.
Laparoscopic (keyhole) surgery: Small cuts using a camera.
Robotic (robot-assisted) surgery: Very small cuts using robotic instruments controlled by the surgeon.
| Feature | Open | Laparoscopic | Robotic |
|---|---|---|---|
| Cut | Large | Small | Very small |
| Blood loss | Higher | Moderate | Lowest |
| Healing | Slow | Faster | Fastest |
| Precision | Lower | Good | Very high |
| Scarring | More | Less | Minimal |
Advantages of Robotic Cystoprostatectomy
- Very small cuts with minimal scarring
- Lowest blood loss
- Fastest healing
- Very high precision
Procedure Details
Instructions Before the Procedure
- Your vital signs (BP, pulse, etc.) will be checked
- Doctor will review your medicines
- Inform about allergies
- You will be asked to fast before surgery
Step-by-Step Overview
- You will be given anaesthesia (put to sleep)
- Small cuts are made in your belly
- The surgeon uses robotic arms to remove the bladder and prostate
- A new pathway is created for urine to leave the body
- The cuts are then closed
Hospital Stay & Recovery
Day of Procedure
- Fasting
- Pre-surgery preparation
After the Procedure
- Tubes may be placed temporarily to help drain urine
- Monitoring of urine, pain and vitals
- Early movement is encouraged
Hospital Stay Duration
Around 5–7 days.
Recovery Timeline
- You will start walking within a day or two
- Most people return to normal activities within 6–12 weeks
Follow-up Schedule
As advised, usually every few months initially.
Benefits and Outcomes
Outcomes depend on early diagnosis, overall health and regular follow-up.
Expected Results
- Removal of cancer
- Better control of disease
Success Rates
Robotic surgery has been shown in studies to work just as well as traditional open surgery for treating cancer.
Quality of Life
- Improved symptoms
- Return to daily activities with proper care
Risks & Complications
Common Risks
- Bleeding
- Blood clots
- Bacterial infection
- Organ damage
- Anaesthesia reactions, including fatigue, headache, sore throat and nausea/vomiting
Activity Restrictions
- Avoid heavy lifting
- Avoid driving initially
- No strenuous exercise
When to Contact a Doctor (Red Flags)
Contact your doctor immediately if you notice:
- Fever or chills (possible infection)
- Continuous nausea or vomiting
- Heavy bleeding from the surgery area
- Increased redness, dark colour, swelling, pain or discharge from the wound
- Pain that is not relieved by your medicines
- Very little urine output
- Urine not draining properly
Lifestyle and Prevention
Diet
- Drink plenty of fluids
- Eat healthy, protein-rich food
Exercise
- Start with walking
- Gradually increase activity
Long-Term Care
- Regular follow-ups
- Monitoring kidney function
- Learning urine bag or new bladder care
Preventing Recurrence
- Stop smoking
- Stay hydrated
- Follow doctor's advice
- Attend regular check-ups
Myths vs Facts
Robot completely performs the cystoprostatectomy.
The surgeon is always in control. The robot only assists with precise movements.
Robotic surgery for bladder cancer is unsafe.
Robotic surgery is safe and widely used, with outcomes similar to open surgery.
Life is not normal after bladder surgery.
Many patients return to normal daily activities, but it may take time and adjustment depending on the type of urinary reconstruction.
Open or laparoscopic cystoprostatectomy is always better.
All approaches (open, laparoscopic and robotic) are effective. The best option depends on the patient's condition and surgeon's expertise.
Frequently Asked Questions
Will I need a urine bag post-surgery?
Some patients may need a urine bag, while others may have a new bladder created. Your doctor will guide you based on your condition.
Is the surgery painful?
You will not feel pain during surgery. After surgery, pain is managed with medicines.
How long will I stay in the hospital?
Usually about 5–7 days, depending on recovery.
Will I be able to walk after surgery?
Yes, you will be encouraged to start walking within a day or two after surgery.
When can I return to normal life?
Most patients return to normal activities within 6–12 weeks, depending on recovery.
Can the cancer come back?
There is a chance cancer can come back, so regular follow-up is very important.
References
- 1. National Cancer Institute. What is bladder cancer. Available from https://www.cancer.gov/types/bladder
- 2. National Cancer Institute. Bladder Cancer Causes and Risk Factors. Available from https://www.cancer.gov/types/bladder/causes-risk-factors
- 3. National Cancer Institute. Bladder Cancer Symptoms. Available from https://www.cancer.gov/types/bladder/symptoms
- 4. National Cancer Institute. Bladder Cancer Diagnosis. Available from https://www.cancer.gov/types/bladder/diagnosis
- 5. National Cancer Institute. Bladder Cancer Treatment. Available from https://www.cancer.gov/types/bladder/treatment
- 6. Lee DJ, Rothberg MB, McKiernan JM, et al. Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report. Can J Urol. 2009;16(3):4664–9.
- 7. Venkatramani V, Reis IM, Gonzalgo ML, et al. Comparison of robot-assisted and open radical cystectomy in recovery of patient-reported and performance-related measures of independence. JAMA Network Open. 2022;5(2):e2148329.
- 8. Cleveland Clinic. Robotic cystectomy. Available from https://my.clevelandclinic.org/health/treatments/21094-robotic-cystectomy
- 9. Parekh DJ, Reis IM, Castle EP, et al. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. The Lancet. 2018;391(10139):2525–36.