Bladder Removal: What You Need to Know

For patients facing advanced bladder cancer, cystectomy – the surgical removal of the bladder – can be a life-saving procedure. But what does it truly involve, and what are the options for life afterward? In this in-depth interview, Peter Zombori speaks with Dr. Daniel Seiler from Urologie Rotes Schloss in Zurich, a leading expert who demystifies cystectomy, detailing modern surgical techniques, options for bladder replacement, and the surprisingly high quality of life many patients achieve.

Peter Zombori: Welcome to our medical talk. Today we will be discussing cystectomy with our top-level expert, Dr. Daniel Seiler from Urologie Rotes Schloss in Zurich (Note: also an attending physician primarily at Hirslanden Klinik im Park and Hirslanden Klinik). Welcome, Dr. Seiler.

Dr. Daniel Seiler: Thank you so much, Peter, for having me.

Peter Zombori: So, as I understand it, cystectomy is often performed when patients have bladder cancer. Could you provide us with a little more insight into this procedure?

Dr. Daniel Seiler: Of course. Thanks for giving me the opportunity to talk to you and explain this. Cystectomy, where we remove the bladder completely, is only performed in patients who have advanced bladder cancer. Mostly, 90% of tumors are superficial, non-muscle invasive bladder cancers. So, most patients with bladder cancer can keep their bladder. However, in some cases—about 10% statistically—we have a situation where the tumor has progressed further and is infiltrating the muscle of the bladder. In these instances, we are forced to remove the bladder completely; this is called a cystectomy.

Normally, we mostly try to perform this using the Da Vinci robotic surgery technique with smaller incisions to remove the bladder completely. After removal, there must be some other place to collect the urine. We have different opportunities and possibilities to kind of replace the bladder. This can be done either by taking some bowel and constructing a new bladder, or we have the possibility to create what's called an ileal conduit. This means we create a urinary stoma, where the urine goes through this opening and is collected in a small bag, which you normally wear on the right side of your abdomen. The procedure performed depends on the patient's age. In older patients, we normally use the ileal conduit, which is this orifice on the abdominal wall. For younger patients, we try to reconstruct a new bladder with bowel so they can more or less have the same quality of life they had before.

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Peter Zombori: How do you do this? How do you reconstruct a bladder?

Dr. Daniel Seiler: We take about 50 centimeters of a part of the bowel and then we kind of reconstruct a ball-like sphere where we try to more or less imitate a bladder. It won't have the exact same quality as your own bladder had before, but it's pretty close to the situation you had before the operation. So, you especially don't have any stoma somewhere, and you normally have more or less the same quality of life as before, though most of those patients have a little bit of incontinence, especially at night.

Peter Zombori: But is the tissue of our bowel and our bladder kind of the same?

Dr. Daniel Seiler: It's definitely not the same. That's still work in progress. That would be our wish for the future: that we could have tissue engineering, where we can grow a new bladder with our own cells, perhaps in a lab, and then put it in. But I think we are still 20 years away, or even more. So, it's not realistic to talk about that research in terms of immediate application. I mean, that's a wish for us, that maybe one day with a printer, we can print out a new bladder. That would be fantastic, but I'm pretty sure I will not profit from that technique in my working day.

Peter Zombori: Okay. So, bladder reconstruction is all noted and understood. And you were saying the quality of life with this technique could be very similar, right?

Dr. Daniel Seiler: Absolutely. And even with a stoma, which means you have a small opening where the urine flows out into a little bag, those people, even though they might initially have a few problems and struggle with the idea of having something like that, often achieve a very good quality of life. Sometimes even better than with their own bladder, because those bladder cancer patients sometimes really suffer from a poor quality of life. They have to go to the toilet very often, sometimes they have to get up 10 times in the night, and their quality of life is super low. So, with that operation, sometimes they see a real improvement in their situation.

Peter Zombori: Dr. Seiler, thank you very much for your time and willingness to share. We appreciate it a lot, and we wish you a very good day. Thanks again.

Dr. Daniel Seiler: Thank you for having me. It was a pleasure again, Peter. See you soon, hopefully.