Bladder Cancer Surgery
Robotic Radical Cystectomy and Urinary Diversion
A radical cystectomy removes the bladder, along with the prostate and seminal vesicles in men or, in women, often the uterus and part of the vaginal wall, together with the pelvic lymph nodes. It is the standard operation for bladder cancer that has grown into the muscle wall of the bladder, and for some non-muscle-invasive cancers that have not responded to treatments placed inside the bladder. It can be performed robotically through small incisions.
Overview
Because the bladder is removed, a new way for urine to leave the body must be created. This is called a urinary diversion. The two most common are an ileal conduit, in which a short segment of intestine carries urine to an opening on the abdomen collected in an external pouch, and a neobladder, in which a segment of intestine is shaped into a reservoir connected to the urethra so that the patient voids through the urethra. The choice depends on the cancer, kidney function, other medical conditions and the patient's preferences.
Who May Be a Candidate
Whether this treatment is appropriate is an individual decision made with your care team. In general it may be considered for:
- Bladder cancer that has invaded the muscle layer of the bladder wall.
- High-risk non-muscle-invasive bladder cancer that has recurred or progressed despite intravesical therapy such as BCG.
- Patients who have discussed chemotherapy before surgery with a medical oncologist, which is recommended for many people with muscle-invasive disease.
- Patients able to undergo a major operation, with a plan for recovery that involves family or other support at home.
What Is Typically Involved
- 1Staging with imaging and, in many cases, cisplatin-based chemotherapy before surgery, coordinated with medical oncology.
- 2A pre-operative visit, nutrition assessment and, for an ileal conduit, a meeting with an ostomy nurse to mark the stoma site and begin teaching.
- 3Surgery under general anesthesia, typically lasting several hours, following an enhanced recovery pathway with early feeding and walking.
- 4A hospital stay of several days while bowel function returns and the diversion is checked.
- 5Teaching on caring for the stoma pouch or, with a neobladder, on catheterization and a voiding schedule.
- 6Follow-up imaging, blood work and visits at intervals set by the care team, with attention to kidney function and vitamin B12 over the long term.
A more detailed, plain-language guide to preparing for and recovering from this surgery, in English and Spanish, is in the Radical Cystectomy patient guide.
Questions Patients Often Ask
What is a urinary diversion?
After the bladder is removed, a segment of intestine is used to create a new route for urine. An ileal conduit brings urine to an opening on the abdomen that is covered by a pouch. A neobladder is an internal reservoir connected to the urethra. Your surgeon will discuss which option fits your cancer, your kidney function and your daily life.
Will I have to wear a bag?
With an ileal conduit, yes. A pouch worn on the abdomen collects urine and is emptied through the day. With a neobladder there is no external pouch, but it requires learning a voiding routine and sometimes catheterization. Neither option is right for everyone, and the decision is made together before surgery.
Why is chemotherapy given before surgery?
For muscle-invasive bladder cancer, chemotherapy given before the operation, called neoadjuvant chemotherapy, is recommended for many patients because it can treat cancer cells that have spread beyond what imaging shows. Whether it is appropriate depends on kidney function and overall health and is decided with a medical oncologist.
How long is recovery?
Recovery from a cystectomy takes longer than from most other urologic operations. The hospital stay is usually several days, and it commonly takes six to eight weeks or more to regain energy and return to usual activities. An enhanced recovery pathway with early eating and walking is used to support this.
Related Procedures
Discuss Your Options
This page is general information and is not a recommendation for any individual. To discuss whether this treatment is appropriate for you, request a consultation through UHealth or call (305) 243-6090. Please do not send personal health information through this website.
Request an AppointmentEducational content reviewed by Archan Khandekar, MD. Last updated 2026-09-19. This material is general in nature, does not constitute medical advice, and does not create a physician-patient relationship. Individual care decisions should be made with your own treating physicians.
Schedule a Consultation
Dr. Khandekar sees patients across the University of Miami Health System and Sylvester Comprehensive Cancer Center. Request an appointment for urologic oncology care.