Radical cystectomy with ileal conduit
Surgery to remove the bladder and nearby lymph nodes for bladder cancer, then use a short piece of small bowel to carry urine to an opening on the belly, where it drains into a bag. It is the most common way to rebuild the urinary tract after the bladder is removed.
Also called radical cystectomy, cystectomy, bladder removal surgery, remove my bladder, ileal conduit, urostomy, urinary diversion, Bricker ileal conduit
- Where
- Hospital operating room
- Anesthesia
- General anesthesia, often with a nerve block or epidural for pain control
- Time in the room
- 4 to 7 hours
- Hospital stay
- Usually 4 to 7 days
- Going home with
- Urostomy bag; thin stents coming out of the stoma for 1 to 3 weeks; sometimes a drain for a few days
- Back to normal
- 2 to 3 months
- Back to work
- 6 to 12 weeks, depending on the job
Overview
A radical cystectomy removes the bladder, the nearby lymph nodes, and nearby organs where bladder cancer tends to spread. Because urine still needs a way out, the surgeon builds a new path in the same operation. With an ileal conduit, the most common choice, a short piece of the small bowel (the ileum) becomes a pipe that carries urine from the kidneys to an opening on the belly called a stoma. Urine drains steadily into a flat bag worn under your clothes.
In men, the prostate and seminal vesicles are removed with the bladder. This is called a cystoprostatectomy. In women, the traditional operation removes the bladder, urethra, uterus and cervix, often the ovaries and fallopian tubes, and part of the front wall of the vagina. This is called an anterior pelvic exenteration. When the cancer allows, many surgeons now spare the uterus, ovaries or vagina in selected women.
For muscle-invasive bladder cancer, most people who are well enough first receive about 2 to 4 months of cisplatin-based chemotherapy. Trials show this helps people live longer, and in some people no cancer is left at all by the time of surgery. The operation can be done robotically through small keyhole incisions or open through one longer incision. Large trials have found similar cancer results with either approach.
This is a major operation. Most people stay in the hospital about 4 to 7 days and need 2 to 3 months to feel like themselves again. Living with a urostomy takes some learning, and most people go back to work, travel, exercise, swimming and intimacy.
The parts of your body involved
The kidneys make urine, which travels down two thin tubes called ureters into the bladder. The bladder stores urine until you empty it through the urethra. The bladder sits low in the pelvis, just behind the pubic bone. In men, the prostate sits just below the bladder with the seminal vesicles behind it. In women, the uterus and vagina lie just behind the bladder. Lymph nodes, small bean-shaped filters, line the blood vessels along the side walls of the pelvis, and bladder cancer often spreads there first. The small bowel, about 20 feet long, lies coiled in the belly just above.
- Kidneys and ureters
The kidneys keep working normally after surgery. The ureters are cut near the bladder and connected to the new conduit.
- Bladder
The muscular bag that stores urine. It is removed whole, with the fat around it, to take out the cancer with a margin of healthy tissue.
- Prostate and seminal vesicles (men)
Glands below and behind the bladder that make fluid for semen. They are removed with the bladder because cancer can spread into them.
- Uterus, ovaries and vagina (women)
These sit right behind the bladder. Some or all may be removed, depending on the cancer, age and wishes about sexual function.
- Pelvic lymph nodes
Small glands along the pelvic blood vessels. They are removed and checked for cancer spread.
- Ileum
The last part of the small bowel. A short piece is borrowed to make the conduit, and the bowel is joined back together.
Why it’s done
Removing the bladder is recommended when bladder cancer has grown into the bladder muscle, or when early cancer is high risk and has not been controlled by treatment inside the bladder. For many of these cancers it offers the best chance of cure.
- Muscle-invasive bladder cancer
Cancer that has grown into the bladder muscle (stage T2 or higher) without spread to distant organs. It is usually treated with chemotherapy first, then cystectomy.
- When BCG has not worked
High-grade early cancer that keeps coming back or persists despite BCG has a real chance of growing into the muscle. Removing the bladder at this point gives a high chance of cure.
- Very high-risk early cancer
Some T1 tumors, such as large or multiple tumors with CIS, or cancer in the urethra inside the prostate, may be best treated by early cystectomy.
- Unusual cell types
Some variant forms of bladder cancer, such as micropapillary or plasmacytoid types, behave more aggressively and are often treated with early surgery.
- Non-cancer reasons
Rarely, cystectomy is done for a bladder badly damaged by radiation, severe bleeding, or a scarred bladder that causes constant pain.
- Why an ileal conduit
It is the simplest and most reliable diversion, with the quickest recovery and fewest long-term problems. It suits most people, including those with weaker kidney function or other health problems, and is needed when the urethra must be removed.
Other options
- Neobladder
A new bladder made from bowel and joined to the urethra, so you urinate through the usual opening without a bag. It needs healthy kidneys, a cancer-free urethra, and commitment to bladder training.
- Continent pouch with a small stoma
An internal pouch made from bowel that you empty with a thin catheter through a small opening on the belly, several times a day. No bag is worn.
- Bladder-sparing chemoradiation
A thorough TURBT followed by radiation with chemotherapy. In carefully selected people with muscle-invasive cancer, long-term results can approach those of surgery and the bladder is kept. Lifelong cystoscopy is needed, and cystectomy is held in reserve if cancer returns.
- Partial cystectomy
Removing only the part of the bladder with the tumor. Suitable for very few people, such as a single tumor at the top of the bladder with no CIS elsewhere.
- Drug treatment alone
For people too ill for surgery or radiation, or whose cancer has spread, chemotherapy, immunotherapy and newer drug combinations can control the cancer for a time.
Getting ready
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Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Anesthesia and positioning
You are given general anesthesia. For robotic surgery, you lie on your back with your legs slightly apart, and the table is tilted steeply head-down so the bowel slides up out of the pelvis. Your arms, legs and face are padded and protected. A catheter is placed in your bladder.
More detail
For open surgery you lie flat on your back. The head-down tilt is why some people have a puffy face or eyelids for a day after robotic surgery.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Waking up
You wake in the recovery room with a urostomy bag, an IV, and possibly a drain. Most people go to a regular surgical floor; a short stay in intensive care is sometimes needed.
- Moving early
Nurses help you sit up and walk the evening of surgery or the next morning. Aim to walk the halls 4 or more times a day and sit in a chair for meals. Walking helps the bowels, lungs and circulation.
- Eating
Most people start sips of liquid the day of or the day after surgery and move to soft food as the bowels wake up. Chewing gum may help. Passing gas is a key sign of progress.
- Pain control
Pain is managed with a nerve block or epidural, acetaminophen, anti-inflammatory medicine when it is safe, and as little opioid as possible. After robotic surgery, aching in the shoulders from the gas is common for a day or two.
- Preventing blood clots
Leg squeeze sleeves and blood thinner shots are used in the hospital. The shots usually continue at home for about 4 weeks after surgery, because the risk of clots stays high after pelvic cancer surgery.
- Learning your stoma
A WOC nurse teaches you and a family member how to empty the bag, change it, connect the night bag, protect the skin, and order supplies. Expect several practice sessions.
- Going home
You are ready to leave when you are eating, passing gas, controlling pain with pills, walking, and able to manage the bag with help. This is usually 4 to 7 days after surgery.
At home
- Stoma and bag care
Empty the bag when it is one-third to half full. Change the wafer and bag every 3 to 5 days, or sooner if it leaks. Measure the stoma at each change for the first 6 to 8 weeks, since it shrinks as swelling goes down.
- Stents
Two thin tubes coming out of the stoma are normal for the first 1 to 3 weeks. They are removed in the clinic, or sometimes fall out on their own. Call if they fall out earlier than expected.
- Fluids
Drink about 8 to 10 cups (2 to 2.5 liters) a day unless told otherwise. Dehydration is one of the most common reasons people return to the hospital after this surgery. Dark urine, dizziness and less urine in the bag are warning signs.
- Eating and bowels
Eat small, frequent meals with plenty of protein. Bowel habits can be irregular for a few weeks. Avoid constipation with fluids, walking and a stool softener if needed.
- Incisions and showering
Showers are fine, with or without the bag on. Pat the incisions dry. Avoid baths, hot tubs and swimming until the incisions are fully healed, usually 4 to 6 weeks.
- Lifting and activity
Walk every day and build up slowly. Do not lift more than about 10 pounds for 6 weeks. After that, lift carefully and ask about a support belt to lower the risk of a bulge (hernia) next to the stoma.
- Driving
Usually after 2 to 4 weeks, once you are off opioid pain medicine and can brake hard without pain. A seatbelt can sit above or below the stoma.
- Blood thinner shots
Continue them for the full course, usually about 4 weeks, as prescribed.
- Sex and intimacy
Most people can resume sex after about 6 weeks. Men may need medicines, injections or devices for erections, and orgasm happens without fluid. Women may notice vaginal shortening or dryness; lubricants, gentle dilators and a pelvic floor therapist help. Empty the bag first, and pouch covers are available.
- Work
Desk work often resumes in 6 to 8 weeks, and physical work in about 12 weeks.
Recovery timeline
- Before surgeryChemotherapy, if recommended
About 2 to 4 months of cisplatin-based chemotherapy, then surgery about 4 to 8 weeks after the last dose.
- Day 0Surgery
Most of the day in the operating room. You wake with a urostomy bag and stents.
- Days 1 to 3Walking and first food
Walking several times a day, sips and soft foods, and waiting for the bowels to wake up. Stoma lessons begin.
- Days 4 to 7Home
Most people go home once eating, passing gas and managing the bag with help.
- Weeks 1 to 3Stents out and pathology
The stents are removed, and your team reviews the final pathology report with you.
- Weeks 4 to 6Healing
Blood thinner shots finish, incisions heal, and the stoma settles to its long-term size. Energy slowly returns.
- 2 to 3 monthsBack to most things
Most people are back to normal activities and many are back at work. The first follow-up scan is often around 3 months.
- First 2 to 3 yearsClose follow-up
Scans every 3 to 6 months and blood tests for kidney function and body salts. Any further treatment is planned based on the pathology.
- Long termYearly checks
Yearly scans and blood tests for several years, including kidney function and vitamin B12, plus stoma and skin checks.
What it feels like
Choosing to have your bladder removed is one of the hardest decisions in urology, and recovery is measured in weeks to months. Most people say the anticipation, especially of the bag, was worse than the reality, and that the first month is the toughest stretch.
Making the decision
Many people feel grief, fear and anger, often mixed with relief that there is a plan to remove the cancer. The idea of a bag can feel unthinkable at first.
What helpsAsk to meet someone who lives with a urostomy; the United Ostomy Associations of America and many hospitals can connect you. Take time to ask every question, and bring a family member to visits.
Meeting the stoma nurse
Seeing a pouch for the first time and having your belly marked can make it suddenly real.
What helpsWearing a pouch filled with a little water for a day before surgery helps many people see that it lies flat and is hidden under clothes.
Waking up
Grogginess, a sore belly, tubes and lines, and sometimes aching shoulders from the gas. Some people feel a strange phantom urge to urinate.
What helpsAsk for pain medicine before pain gets strong. The phantom urge fades over days to weeks.
First look at the stoma
Surprise at how red and swollen it looks, sometimes tears. Some people do not want to look at all for a few days.
What helpsThe swelling shrinks a great deal over the first 6 to 8 weeks. Looking at it with your nurse beside you helps.
The bowels waking up
Bloating, hiccups, nausea and no appetite for a few days can be frustrating, and some people vomit.
What helpsWalking, chewing gum and patience. If the bowels stay slow, a tube through the nose for a few days can relieve pressure while they recover.
The first bag change
It can feel slow, messy and awkward, and urine can drip onto the skin while you work.
What helpsChange it in the morning before drinking, when urine flow is slowest. Lay out supplies first. Within a few weeks most people do it in 10 to 15 minutes.
The first weeks home
Tiredness is the most common complaint. Some people feel low or anxious, and sleep is broken by the night bag at first.
What helpsPlan short walks and rests. Drink steadily through the day. Tell your team about low mood; it is common and treatable.
Getting your life back
Worry about smell, leaks, clothes and intimacy. Then, for most people, a slow return of confidence.
What helpsModern pouches are odor-proof and flat. A support group or a WOC nurse can solve most practical problems. Many people swim, travel and play sports again.
How well it works
The goals are to remove all the cancer and to give you a reliable, low-maintenance way to pass urine. The pathology report, usually ready 1 to 2 weeks after surgery, shows how far the cancer had grown, whether the edges of the specimen are clear, and whether any lymph nodes contain cancer.
- Stage at surgery
Finding no cancer left in the bladder after chemotherapy is a very good sign. Cancer that is still inside the bladder wall carries a better outlook than cancer that has grown through it.
- Clear margins
Healthy tissue around the cancer on all sides means it was removed completely.
- Lymph nodes
Cancer in the lymph nodes, or deep cancer after chemotherapy, may lead to treatment after surgery, such as immunotherapy, to lower the chance of return.
- Follow-up scans
CT or MRI scans every 3 to 6 months for the first 2 to 3 years, then yearly, along with blood tests of kidney function and body salts.
- A working conduit
Steady urine flow into the bag, healthy skin around the stoma, and stable kidney function on blood tests show the diversion is working well.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Because this is a big operation, most people have at least one problem during recovery, most of them minor and treatable.
The bowels take longer to wake up, causing bloating, nausea and vomiting. Treated with rest for the bowel, fluids by IV, and sometimes a tube through the nose for a few days.
Urinary infections, kidney infections and wound infections are common after this surgery. Most are treated with antibiotics.
Often for dehydration, infection or slow bowels. Most readmissions are short.
In one large trial, about 1 in 4 people after robotic surgery and almost 1 in 2 after open surgery needed a transfusion.
Most men have erection problems afterward unless nerves could be spared, and no man ejaculates fluid. Women may have a shorter or drier vagina, and early menopause if the ovaries are removed.
Less common
The risk is higher after pelvic cancer surgery, which is why blood thinner shots continue for about 4 weeks.
Urine can leak where the ureters join the conduit, or bowel contents where the bowel was rejoined. Leaks may need a drain, longer stents, or another operation.
Scar tissue where a ureter joins the conduit can slowly block a kidney, often months or years later, and kidney function can decline or stones can form over the years. Lifelong scans and blood tests find these early; a blockage is treated with a tube, stent or surgery.
A bulge around the stoma that can develop over years. Many people need only a support belt; some need repair.
A pocket of fluid where lymph nodes were removed. Most go away; some need drainage.
Despite every care, a small number of people die within 90 days of this operation, more often older people and those with heart, lung or kidney disease. Ask your surgeon about your own risk.
Rare
Usually seen and repaired during surgery.
More likely in people with existing heart or lung disease.
Scar tissue can kink the bowel, sometimes years later. Most settle with rest for the bowel; a few need surgery.
Poor blood supply to the stoma early on, or narrowing later, can require a revision.
Injury to the obturator nerve during node removal can weaken the inner thigh. Usually recognized and repaired at surgery.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills.
- Little or no urine in your bag for 4 hours or more, even though you are drinking.
- Repeated vomiting, a swollen hard belly, or no gas or stool for more than 2 days.
- Signs of dehydration: dizziness when standing, very dark urine, a dry mouth, or feeling faint.
- The stoma turns dark purple, black or very pale, or sinks below the skin.
- Redness, swelling or pus at an incision, or fluid leaking from an incision.
- New pain in your back or side, especially with fever.
- Pain or swelling in one leg, or sudden chest pain or shortness of breath: call 911.
Questions to ask your surgeon
- Do you recommend chemotherapy or immunotherapy before surgery for me?
- Will you do my surgery robotically or open, and how many cystectomies do you do each year?
- Am I a candidate for a neobladder or a continent pouch, and why do you suggest an ileal conduit?
- Can any nerves be spared, or for women, can the uterus, ovaries or vagina be spared?
- How extensive will the lymph node removal be?
- When will I meet the stoma nurse, and where will my stoma be?
- How long will I be in the hospital, and what help will I need at home?
- What are the most common complications in your patients, and how are they handled?
- When will the stents come out?
- What will my follow-up scans and blood tests look like?
- Will I need treatment after surgery based on the pathology?
- How do I get supplies, and who do I call after hours with a stoma problem?
Words you may hear
- Pneumoperitoneum
- The gas-filled belly that makes keyhole surgery possible. Carbon dioxide is pumped in through a thin needle or the first port until the belly wall lifts like a tent (usually at a pressure of 12 to 15 mmHg), giving the camera and instruments room to work. The gas is let out at the end, and the little that remains is absorbed and breathed out over a day or two; it can cause shoulder-tip ache in the meantime.
- Radical cystectomy
- Removal of the whole bladder, nearby organs and nearby lymph nodes for cancer.
- Cystoprostatectomy
- Removal of the bladder together with the prostate and seminal vesicles in men.
- Anterior pelvic exenteration
- In women, removal of the bladder, urethra, uterus, cervix and part of the front vaginal wall, often with the ovaries.
- Ileal conduit
- A short piece of small bowel used as a pipe to carry urine from the ureters to a stoma.
- Urostomy
- A stoma that drains urine. People often use the word for the whole bag system.
- Stoma
- The opening of bowel on the belly where urine comes out.
- Ileum
- The last part of the small bowel.
- Ureteral stents
- Thin plastic tubes that keep urine flowing across the new connections while they heal.
- Lymph node dissection
- Removing lymph nodes to check for and remove cancer spread.
- Neoadjuvant chemotherapy
- Chemotherapy given before surgery to shrink the cancer and treat hidden spread.
- Enhanced recovery after surgery (ERAS)
- A set of steps before, during and after surgery, such as early eating and walking and fewer opioids, that speed recovery.
- WOC nurse
- A wound, ostomy and continence nurse who specializes in stoma care.
- Ileus
- A slowdown of the bowel after surgery that causes bloating and nausea.
- Parastomal hernia
- A bulge of bowel through the belly wall next to the stoma.
- Wafer
- The sticky skin barrier that holds the bag around the stoma.
Common questions
Will I always need to wear a bag?
Yes. With an ileal conduit, urine drains all the time, so a bag is worn at all times and emptied during the day, with a larger bag connected at night.
Can people tell I have a urostomy?
Usually not. Modern pouches are flat, odor-proof and hidden under ordinary clothes. Many people choose not to tell anyone outside close family.
Can I shower, swim and exercise?
Yes. You can shower with the bag on or off. Once you have healed, you can swim with the bag on and return to most sports. Ask about a support belt for heavy lifting.
How often do I change the bag?
Most people change the wafer and bag every 3 to 5 days and empty it several times a day, when it is one-third to half full.
Why have chemotherapy first if it delays surgery?
Chemotherapy before surgery treats cancer cells that may already have spread in tiny amounts. Trials showed people lived longer when they got it first. The short delay does not harm results when chemotherapy is given as planned.
Can I switch to a different type of diversion later?
It is possible in rare cases, but it is a major operation. It is best to talk through the options and decide before surgery.
Will insurance cover my supplies?
Medicare and most insurance plans cover urostomy supplies, usually with monthly limits. Your stoma nurse can help you set up a supplier.
Will my urine look different?
Yes. Urine from a conduit contains white strands of mucus, made by the bowel lining. This is normal and lessens with time. Drinking plenty of fluids helps.
Sources this page draws on
- American Urological Association, ASCO, ASTRO and Society of Urologic Oncology, Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline
- European Association of Urology, EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer
- SWOG (Southwest Oncology Group), Trial 8710: neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone (Grossman and colleagues, New England Journal of Medicine) (2003)
- RAZOR trial investigators, Robot-assisted versus open radical cystectomy in bladder cancer (Parekh and colleagues, The Lancet) (2018)
- iROC trial investigators, Robot-assisted radical cystectomy with intracorporeal urinary diversion versus open radical cystectomy (Catto and colleagues, JAMA) (2022)
- American Cancer Society, Urostomy Guide
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.