Q: Can You Live Without a Bladder?
Answer: Yes! You can definitely live without a bladder.
Q: How Long Can You Live Without a Bladder?
Answer: After bladder removal, surgeons create a new way for urine to be stored in the body and leave the body. With appropriate treatment and follow-up care, many people can live full, active lives after bladder removal.
Life expectancy depends much more on the underlying condition and reason for the cystectomy (the type of cystectomy and stage of cancer, for example) and a person’s overall health than on the absence of the bladder itself.
A radical cystectomy removes the entire bladder and is most commonly performed for bladder cancer. Depending on the person’s anatomy and disease, nearby reproductive organs and lymph nodes may also need to be removed.
A partial cystectomy removes only the diseased portion of the bladder while preserving the remainder. It is appropriate for only select conditions and bladder cancers because the remaining bladder must still function adequately, and the disease must be safely removable.
Q: What Is the Most Common Reason Someone Undergoes Bladder Removal Surgery?
Answer: The most common reason for radical bladder removal is bladder cancer, particularly muscle-invasive bladder cancer or certain high-risk non-muscle-invasive cancers that have not responded adequately to other treatments.
Q: What Are Some Other Common Reasons Someone Would Need Bladder Removal Surgery?
Answer: Although cancer is the primary reason, cystectomy may occasionally be considered for severe noncancerous conditions when other treatments have failed.
These can include significant bladder damage from radiation, severe refractory bladder dysfunction or pain, interstitial cystitis, certain congenital conditions, or extensive injury.
Bladder removal is considered major surgery, so for benign conditions it is generally reserved for carefully selected patients after more conservative options have been exhausted.
Q: What Are the Risks of a Cystectomy?
Answer: Cystectomy is a major surgical operation. Potential risks include bleeding, infection, blood clots, bowel complications, urinary infections, kidney or ureter problems, electrolyte or metabolic changes, and complications related to the urinary diversion.
Long-term changes can also include urinary leakage, difficulty emptying, sexual dysfunction, changes in body image, and quality-of-life concerns.
Understanding these possibilities before surgery helps patients prepare and identify resources for recovery.
Utilizing a mental health therapist can be helpful while patients are navigating their options.
Q: How Can You Prepare for a Cystectomy?
Answer: Preparation should address more than the surgery itself, as well as psychosocial impacts. Patients should discuss:
- Which urinary diversion best fits their health and lifestyle
- Nutrition, physical activity, medications, and smoking cessation before surgery
- Stoma education if an ileal conduit is planned
- Pelvic floor rehabilitation when appropriate
- Sexual health and fertility concerns
- Expected recovery and support needed at home
- Mental health impact
I encourage patients to ask what life will look like after recovery, and not simply what will happen during the operation. Joining a support group or talking to someone who has gone through the surgery can also be helpful.
Q: After Bladder Removal, How Does a Patient Store & Release Urine?
Answer: There are three primary types of urinary diversion [created to help a patient store and release urine]:
Ileal conduit → Urine drains continuously through a stoma into an external collection pouch.
Neobladder → A new internal reservoir is created from the intestine and connected to the urethra, allowing urine to pass through the urethra.
Continent cutaneous reservoir → An internal pouch stores urine and is emptied using a catheter through a small abdominal opening.
The best option depends on the person’s health, anatomy, diagnosis, kidney function, lifestyle, and personal preferences, and should be made in a shared decision-making environment with the patient’s medical provider.
Q: How Is Daily Life Different Without a Bladder?
Answer: There is certainly an adjustment period, but many people return to work, exercise, travel, relationships, and the activities they enjoyed before surgery. That timeline will look unique to each individual.
Daily routines depend on the urinary diversion. Someone with an ileal conduit learns pouch and skin care. Someone with a neobladder may initially urinate on a schedule, work on continence, and occasionally need catheterization. Someone with a continent reservoir catheterizes the pouch regularly and will build that into their routines.
Education and support make a tremendous difference in helping patients regain confidence and independence.
Q: Do You Have Any Additional Insights You’d Like to Share?
Answer: One aspect of cystectomy care that deserves more attention is the quality of life after surgery. Removing the bladder changes urinary function, but treatment can also affect sexual function, intimacy, body image, pelvic health, and emotional well-being.
The conversations need to be ongoing and don’t end when the surgery does.
These conversations should begin before surgery and not after a patient develops a problem. Ask about urinary diversion options, sexual-function preservation, fertility when relevant, pelvic floor rehabilitation, ostomy support, and sexual medicine resources.
The goal isn’t simply to successfully remove the bladder. It is to help the person return to a meaningful, active, and satisfying life afterward.
Consider referrals to mental health therapists, wound care, and pelvic floor therapists BEFORE surgery as well.
About Aeroflow Urology:
Aeroflow Urology, a subsidiary of Aeroflow Health, is a leading provider of high-quality incontinence supplies, such as diapers, bladder control pads, and more, through insurance. We specialize in navigating insurance guidelines to ensure that every person gets the most value out of their insurance benefits.
About Aleece Fosnight:
Aleece Fosnight is a board-certified physician assistant specializing in sexual medicine, women’s health, and urology.
In 2019, Fosnight opened up her own private practice, the Fosnight Center for Sexual Health, and implemented the sexual health grand rounds curriculum at her local hospital and residency program.
Fosnight is also the founder of the Fosnight Foundation, a non-profit organization dedicated to the education and training of professionals in the sexual health field and providing funding for access to healthcare services in her local community.
References:
Bladder Cancer Advocacy Network. (2024, September 16). Bladder Removal Surgery: What is a Cystectomy?
Sobhani, S., Ghoreifi, A., Douglawi, A., Ahmadi, H., Miranda, G., Cai, J., Aron, M., Schuckman, A., Desai, M., Gill, I., Daneshmand, S., & Djaladat, H. (2023). Perioperative mortality for radical cystectomy in the modern Era: experience from a tertiary referral center. International braz j urol : official journal of the Brazilian Society of Urology, 49(3), 351–358.
This article was developed in partnership with, and sponsored by Aeroflow. NAFC collaborates with select partners to bring our community information and resources that support bladder and bowel health.
