Bladder cancer surgery (cystectomy)
A major operation to remove the whole bladder, and usually nearby structures, to treat bladder cancer, with a new way created for urine to leave the body.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Cystectomy removes the whole bladder to treat invasive or high-risk bladder cancer, with a new route created for urine, often a stoma and bag.
- It is major surgery with significant risks and a real change to how you pass urine and to your body.
- The plan is set by a specialist cancer team after staging scans, and chemotherapy is often given first; surgery aims to remove the cancer but cannot guarantee a cure.
- Bladder-preserving treatment with radiotherapy and chemotherapy is an alternative for some people, so ask about all your options.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Removes the cancer-containing bladder, giving the best chance of controlling muscle-invasive cancer for many people
People who are not fit enough to safely undergo and recover from major surgery, where other treatments may be safer.
You are monitored closely, with tubes, drains and pain relief such as an epidural. The team helps you start sipping, eating and moving, and waits for your...
Care within a specialist cancer team, with a clear plan and named contacts.
You are monitored closely, with tubes, drains and pain relief such as an epidural. The team helps you start...
If you have a stoma, you learn to care for it with a stoma nurse. Tubes and drains are removed as you progress...
You build up activity gradually at home. Tiredness is common, and you avoid heavy lifting to protect the wound and...
Energy and strength continue to return. You get the laboratory results and a plan for any further treatment and...
What is bladder cancer surgery (cystectomy)?
A radical cystectomy is an operation to remove the whole bladder. It is used mainly for bladder cancer that has grown into the bladder muscle (muscle-invasive cancer), and sometimes for high-risk cancer that has not invaded the muscle but keeps coming back or does not respond to other treatment.
As well as the bladder, the surgeon usually removes nearby lymph nodes and, depending on your sex, other nearby structures — often the prostate in men, and sometimes the womb, ovaries and part of the vagina in women. Because the bladder is removed, the surgeon also creates a new way for urine to leave the body (a urinary diversion). The most common is an ileal conduit, where a short piece of bowel carries urine to an opening on the tummy (a stoma) into a bag. Some people are suitable for a neobladder, where a new pouch is made from bowel so they can pass urine more normally.
This is major surgery and a major life change. The decision is made by a specialist cancer team (a multidisciplinary team, or MDT) after scans to stage the cancer, and is often combined with chemotherapy before surgery. Radiotherapy with chemotherapy is an alternative for some people who prefer to keep their bladder or are not fit for the operation.
It is important to be clear that surgery aims to remove the cancer, but it cannot be promised to cure it. The outlook depends on the stage and type of cancer and what is found at operation.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Treatment options for invasive bladder cancer
| Cystectomy | Chemo-radiotherapy | |
|---|---|---|
| Bladder kept | No | Often yes |
| Main treatment | Surgery | Radiotherapy + chemo |
| Stoma/diversion | Usually needed | Not usually |
| Ongoing checks | Yes | Yes, including bladder checks |
Both can be appropriate, depending on the cancer and your health and wishes. A specialist cancer team should discuss both with you before you decide.
Preparing for your surgery
- Make sure your case has been discussed by a specialist cancer multidisciplinary team, and ask what stage your cancer is.
- Ask whether chemotherapy before surgery is recommended, as it often is for muscle-invasive cancer.
- Ask about all options, including bladder-preserving treatment with radiotherapy and chemotherapy.
- Meet a stoma care nurse before surgery to learn what a stoma involves and where it would sit, if a stoma is planned.
- Discuss which type of urinary diversion suits you, and what daily life with each is like.
- Tell the team about all your health problems and medicines, as fitness for major surgery matters; you may have pre-operative tests.
- Stop smoking if you can, and follow advice on improving your fitness and nutrition before surgery.
- Plan for a hospital stay of about a week or more and a recovery of two to three months at home.
What happens
The operation is done under a general anaesthetic, usually with an epidural or spinal injection to help control pain afterwards. It takes several hours.
The surgeon removes the bladder along with nearby lymph nodes and, depending on your sex, other nearby structures. They then create the urinary diversion — most often an ileal conduit, using a short piece of bowel to carry urine to a stoma on the tummy, or sometimes a neobladder made from bowel. The removed tissue is sent to the laboratory to examine the cancer and check the edges (margins).
Afterwards you are looked after closely, often with tubes and drains for a time, and the team helps you start eating, moving and, if you have a stoma, learning to care for it before you go home. Most people stay in hospital for about a week or longer.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- People who are not fit enough to safely undergo and recover from major surgery, where other treatments may be safer.
- Those whose cancer has spread widely, where surgery may not be the best treatment and the team may advise chemotherapy or other care.
- People who, after full discussion, prefer bladder-preserving treatment and are suitable for it.
- Anyone who has not had their case reviewed by a specialist cancer multidisciplinary team.
Delay surgery if…
- There is an active infection that needs treating before major surgery.
- Recommended chemotherapy before surgery is still being given or planned.
- Your fitness, nutrition or other health problems need optimising first.
- Staging is incomplete or further scans are needed to plan treatment.
Alternatives to discuss
- Radiotherapy combined with chemotherapy to treat the cancer while keeping the bladder, for suitable people.
- Chemotherapy or, in some cases, immunotherapy as part of the plan.
- Best supportive care focused on symptoms and quality of life, where appropriate.
- A different type or timing of surgery, as advised by the cancer team.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Removes the cancer-containing bladder, giving the best chance of controlling muscle-invasive cancer for many people
- Allows the cancer to be fully examined and staged from the removed tissue
- Can relieve symptoms such as bleeding or pain from an advanced bladder tumour
- Removes nearby lymph nodes, which helps assess and treat the cancer
Risks & complications
- Pain, tiredness and a long recovery after major surgery
- The bowel being slow to work again (ileus), delaying eating and discharge
- Needing a blood transfusion
- Wound and urine infections
- A permanent change to how you pass urine, usually a stoma and bag
- A blood clot in the leg or lungs
- Leakage where the bowel or urinary system is joined, sometimes needing further treatment
- Problems with the stoma, such as narrowing, leaking or a hernia around it
- Chest infection or other organ strain after a long operation
- Serious complications that risk life; major surgery of this kind carries a small but real risk of death
- Severe bleeding or injury to nearby organs needing further surgery
- Long-term kidney problems or vitamin and salt imbalances from the diversion
- The cancer being more advanced than expected, or returning despite surgery
Radical cystectomy is one of the bigger operations in urology, and complications are common: large studies report that a substantial proportion of patients have a complication, and there is a small but real risk to life (90-day death rates of around 3% are reported). Longer-term, a stoma and the use of bowel for the diversion can lead to problems such as parastomal hernia, bowel disturbance, urine infections, kidney changes and vitamin or salt imbalances. Ask about your surgeon's and hospital's experience and results, how complications are managed, and what support you will have with a stoma.
Published figures to discuss
Cystectomy has a high overall complication rate and a small but real risk to life, and these vary with your age, fitness, the type of diversion, the surgical approach and the hospital's experience. The figures below are cautious ranges from published series, not a personal prediction. Longer-term complications relate mainly to the urinary diversion and the use of bowel. The chance of the cancer being controlled depends on its stage and is decided with the cancer team, not by surgery alone.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Overall complications after surgery | High; systematic reviews report roughly 19–64%, and a recent large cohort reported about 46% within 90 days | Wide range reflects differences in how complications are recorded and patient mix; many are minor, some are major. | 90-day morbidity and mortality after radical cystectomy in a large database — Canadian Urological Association Journalcuaj.caPublished figure |
| Death within 90 days of surgery | Usually around 3–5% in large modern series and reviews | A small but real risk; higher in older or less fit patients. Discuss your personal risk with your team. | 90-day morbidity and mortality after radical cystectomy in a large database — Canadian Urological Association Journalcuaj.caPublished figure |
| Long-term complications of an ileal conduit | Common over years; parastomal hernia alone is often reported in roughly a quarter to a half of patients depending on follow-up and definition | Includes parastomal hernia, infections, stones, and vitamin or salt imbalances; needs ongoing monitoring. | 90-day morbidity and mortality after radical cystectomy in a large database — Canadian Urological Association Journalcuaj.caSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from a cystectomy is a major undertaking. Expect about a week or more in hospital and around two to three months before you feel substantially recovered, with adjustment to a new way of passing urine continuing beyond that.
- Marked tiredness and reduced stamina for weeks to months
- A sore, healing tummy wound and a settling-in period for a stoma or neobladder
- A slow return of normal appetite and bowel habit
- Emotional ups and downs while adjusting to the changes and the cancer diagnosis
Aftercare
- Work with your stoma nurse to become confident caring for a stoma, if you have one.
- Take blood-clot prevention as advised, which may continue for some weeks after you go home.
- Avoid heavy lifting and strenuous activity in the early weeks to protect the wound and reduce hernia risk.
- Keep well hydrated and follow advice on diet as your bowel recovers.
- Attend appointments for results, any further treatment, and follow-up scans and checks.
- Take any prescribed vitamins or supplements, as the diversion can affect absorption.
- Know who to contact about stoma problems, signs of infection or other concerns.
- Confirmation your case has been through a cancer multidisciplinary team
- A meeting with a stoma care nurse before surgery
- A clear discussion of which urinary diversion you will have and why
- Help and support arranged at home for several weeks
- Time off work arranged (around 2–3 months, longer for physical jobs)
- Knowing the warning signs and who to contact after discharge
Scars and how they heal
Open surgery usually leaves a scar down the middle of the tummy; keyhole or robotic surgery uses several smaller cuts. If you have a stoma, there will be a permanent opening on the tummy where the bag attaches. Scars fade over months but can be thickened or sensitive. A hernia can sometimes develop around the stoma or in the wound over time.
⚠ Get urgent help if…
- Fever, chills or feeling very unwell — possible serious infection, seek urgent help
- Calf pain or swelling, or sudden breathlessness or chest pain — possible blood clot, seek urgent help
- Severe or worsening tummy pain, vomiting, or no urine draining from the stoma or catheter
- Spreading redness, heat or discharge from the wound, or the wound opening
- Heavy bleeding, or blood in urine draining from a neobladder or catheter
- The stoma changing colour (dark or black), pulling in, or stopping working
- Being unable to keep fluids down, or signs of dehydration
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the cancer is removed with clear margins and no spread to the lymph nodes, giving the best chance of controlling the disease. The full picture only becomes clear once the removed tissue is examined, and the cancer is sometimes more advanced than the scans suggested.
Surgery aims to remove the cancer but cannot be promised to cure it; the outlook depends on the stage, grade and type of cancer and whether it has spread. Some people are advised to have further treatment, such as chemotherapy, and everyone has long-term follow-up to watch for the cancer coming back and to check the kidneys and the diversion.
Living without a bladder is a permanent change. A stoma and bag, a neobladder or a continent diversion each become part of daily life and usually work well with support, though they need ongoing care and can develop problems over the years, such as a hernia, infections, stones or kidney changes. Because bowel is used to make the diversion, some people need long-term vitamin or salt monitoring. Whether the cancer stays away depends on its stage and behaviour, which is why long-term follow-up continues for years.
Combining with other procedures
Cystectomy is often part of a wider treatment plan. Chemotherapy is frequently given before surgery for muscle-invasive cancer, and sometimes afterwards. The lymph nodes are usually removed at the same operation. Decisions about combining treatments are made by the specialist cancer team based on your scans and the laboratory results.
Follow-up & long-term care
After surgery you receive the laboratory results and a plan for any further treatment. Long-term follow-up includes appointments and scans to watch for the cancer returning, and checks on your kidneys, the diversion and your vitamin and salt levels. Report stoma problems, infections, bleeding or new symptoms between visits.
- Ongoing stoma or neobladder care, with access to a stoma nurse for problems.
- Long-term follow-up scans and appointments to monitor for recurrence.
- Blood tests to check kidney function and vitamin and salt levels.
- Vitamin B12 or other supplements if advised, because bowel is used in the diversion.
- Prompt review of any hernia, infection, stone or stoma problem.
Revision and secondary surgery reality
- A stoma or diversion can develop problems over time, such as a parastomal hernia, narrowing or stones, sometimes needing further surgery.
- Some people need additional cancer treatment after surgery depending on the laboratory results.
- If the cancer returns, further treatment is guided by the cancer team.
- Long-term monitoring of the kidneys and of vitamin and salt levels is part of life after the operation.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Care within a specialist cancer team, with a clear plan and named contacts.
- Skilled stoma nursing support before and after surgery.
- Active blood-clot prevention and clear warning-sign advice.
- Structured long-term follow-up with scans and blood tests for recurrence, kidney function and vitamin and salt levels.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The surgeon's fee and whether the operation is open, keyhole or robotic
- Anaesthetic fee, including epidural or spinal pain relief
- Theatre and a hospital stay of about a week or more, sometimes including intensive or high-dependency care
- The type of urinary diversion and any devices used
- Stoma care, supplies and nursing support
- Scans for staging and long-term follow-up
- Any chemotherapy before or after surgery, and treatment of complications
- The operating surgeon's fee
- Anaesthetist's fee and pain-relief arrangements
- Theatre, ward and any intensive-care costs for a stay of about a week or more
- Stoma care, supplies and ongoing nurse support
- Staging scans and long-term follow-up appointments and scans
- Whether chemotherapy before or after surgery is included
- What happens, and who pays, if complications occur or further treatment is needed
On the NHS? Cystectomy is a standard NHS treatment for invasive and high-risk bladder cancer, planned by a specialist cancer team; the multidisciplinary approach should be the same in private care.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being offered, or told about, bladder-preserving treatment as an alternative.
- No honest discussion that surgery aims to remove the cancer but cannot promise a cure.
- Not meeting a stoma nurse or understanding daily life with the chosen diversion before agreeing.
- No clear discussion of effects on sexual function, fertility, kidneys and long-term health.
Marketing red flags
- Any promise of a cure or a 'cancer-free' guarantee.
- Presenting surgery as the only option without mentioning chemo-radiotherapy.
- Downplaying the seriousness, the risks or the reality of living with a diversion.
- Promoting a particular technique (such as robotic surgery) as without risks.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- What stage and type is my cancer, and has my case been through the multidisciplinary team?
- Should I have chemotherapy before surgery, and what does it add?
- Is bladder-preserving treatment with radiotherapy and chemotherapy an option for me?
- Which urinary diversion do you recommend for me, and what is daily life like with it?
- What are your and the hospital's results and complication rates for this operation?
- How will surgery affect my sexual function, fertility and kidneys in the long term?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will surgery cure my bladder cancer?
Will I have to wear a bag?
Is there an alternative to having my bladder removed?
Is this done on the NHS?
How long is the recovery?
How risky is the operation?
How will this affect sex and fertility?
Find a verified surgeon for bladder cancer surgery (cystectomy)
Every consultant is GMC-checked and independently reviewed. Search by postcode and distance, or switch to a map. Ordered by rating, relevance and recency — never by who pays.
No verified consultants list this procedure yet — browse the full directory.
How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Cancer Research UK — Treatment options for muscle-invasive bladder cancer BAUS — Bladder procedures (patient leaflets, incl. radical cystectomy) NHS England — Guidelines for the management of bladder cancer (MDT, staging) 30-day and 90-day morbidity and mortality of radical cystectomy: neobladder vs ileal conduit (PubMed) Quality of life after cystectomy: ileal conduit vs neobladder (PMC) Parastomal hernia after cystectomy and ileal conduit — systematic review (PMC) Short-term morbidity and mortality following radical cystectomy — BMJ Open 90-day morbidity and mortality after radical cystectomy in a large database — Canadian Urological Association Journal
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Bladder tumour removal (TURBT) · Bladder Botox injections · Circumcision (adult) · Epididymal cyst removal · Hydrocele repair