Urinary diversion
If your bladder is removed during a radical cystectomy, an alternative way of passing urine out of your kidneys will need to be found.
There are a number of different treatment options, which are described below. In some cases, you may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone.
Your multi-disciplinary team (MDT) will be able to provide you with information about which option(s) are suitable for you.
Urostomy
A urostomy is the most common type of urinary diversion operation. During the operation, the surgeon will make a hole in your abdominal wall. The hole is known as a stoma.
A small section of your small bowel will be removed and connected to your ureters (the two tubes that normally carry urine out of the kidneys). The other end of the small bowel will be connected to your stoma. A flat, water-proof pouch will be connected to the stoma to collect the urine.
After the operation, you will be introduced to a stoma nurse who will teach you how to care for your stoma and how and when to change the pouch. Most people will need to empty their pouch the same number of times a day that they would usually pass urine.
The Urostomy Association are a UK based charity who provide information and assistance to people who have recently had, or are about to have, a urostomy.
Continent urinary diversion
A continent urinary diversion is a similar type of operation to an urostomy, but it does not involve using a pouch. Instead, a section of your bowel will be used to create an internal pouch that is used to store urine.
The pouch will be connected to your ureters at one end and to a stoma that is made in your abdominal wall at the other end. The pouch can be emptied by inserting a catheter (a thin, flexible tube) into the stoma to drain away the urine. Most people need to empty their pouch about four or five times a day.
Bladder reconstruction
In some cases, it may be possible to create a new bladder, known as a neobladder. This involves removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra at one end and your ureters at the other end.
Bladder reconstruction is not a suitable treatment for everyone. For example, it cannot be used if the cancer has spread to your urethra because your urethra will have to be removed.
You will be taught how to empty your neobladder by relaxing the muscles in your pelvis while at the same time tightening the muscles in your abdomen.
Your neobladder will not contain the same types of nerve endings as a real bladder so you will not get the distinctive sensation that tells you that you need to pass urine. Some people experience a feeling of fullness inside their abdomen while others have reported that they feel like they need to pass wind.
Due to the loss of normal nerve function, around 1 in 4 people with a neobladder will experience some episodes of urinary incontinence (involuntary passing of urine), which usually occurs during the night while asleep.
You may find it useful to empty your neobladder at set times during day, including before you go to bed because this may help to prevent incontinence.
Guy’s and St Thomas’ Hospital Trust has more information and advice about creating and living with a neobladder (Pdf - 80KB).
Sexual problems
Erectile dysfunction
You should contact your GP if you lose the ability to obtain or maintain an erection. It may be possible for you to be treated with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis.
The most commonly used PDE5 is sildenafil (Viagra). However, other PDE5s are available if sildenafil is not effective.
An alternative to PDE5s is a device called a vacuum pump, which consists of a tube that is connected to a pump. The penis is placed inside the tube and the air is pumped out. This creates a vacuum that causes blood to rush to the penis. A rubber ring is then placed around the base of the penis, which keeps the blood in place and allows an erection to be maintained for around 30 minutes.
Read more about treating erectile dysfunction.
Narrowing of the vagina
Both radiotherapy and cystectomy can cause a woman’s vagina to become shortened and narrowed, which can make having sex painful or difficult.
There are two main treatment options available if you have a narrowed vagina. The first is to apply hormonal cream to your vagina which should help to increase moisture inside your vagina, making sex easier. The second is to use a vaginal dilator. This is a tampon shaped device that is made out of plastic and designed to help make your vagina more supple.
It is usually recommended that you insert the dilator for five to ten minutes at a time on a regular basis during the day over the course of six to 12 months.
Many women find this an embarrassing issue to discuss but it is a standard and well recognised treatment for narrowing of the vagina. Your specialist cancer nurse should be able to provide you with more information and advice.
You may also find that the more times you have penetrative sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.
Macmillan Cancer Support has some excellent information and a video about sexuality and cancer.
Emotional impact
The emotional impact of living with bladder cancer can be significant. Many people report experiencing a kind of ‘roller-coaster’ effect.
For example, you may feel very down at receiving a diagnosis, feel up when you get confirmation that the cancer has been removed from your body and then feel down again as you try to come to terms with the after effects of your treatment.
This type of emotional disruption can sometimes trigger feelings of depression. Signs that you may be depressed include:
- being bothered during the past month by feeling down or hopeless
- no longer taking pleasure in the things you enjoy
You should contact your GP for advice if you think you may be depressed. There are a range of relatively successful treatment for depression, such as antidepressant medication and talking therapies, such as cognitive behavioural therapy (CBT).
Read more about depression and coping with cancer.
