Open Radical Cystoprostatectomy & Urethrectomy
What Is Open Radical Cystoprostatectomy & Urethrectomy?
Open radical cystoprostatectomy and urethrectomy is a major surgical procedure performed to treat certain cancers affecting the bladder, prostate and urethra. During the operation, the surgeon removes the entire bladder, prostate gland, seminal vesicles and the urethra through an open abdominal incision. Because the bladder is removed, a urinary diversion is created to allow urine to leave the body, such as an ileal conduit or a continent urinary reservoir. The procedure aims to remove all cancerous tissue while reducing the risk of recurrence and preserving the patient's overall health whenever possible.
What Are the Benefits of Open Radical Cystoprostatectomy & Urethrectomy?
This procedure offers several important benefits for appropriately selected patients, including:
- Complete removal of cancer involving the bladder and urethra.
- Reduced risk of local cancer recurrence.
- Treatment of invasive or high-risk bladder cancer.
- Removal of adjacent organs that may contain cancer cells.
- Opportunity to perform lymph node removal for accurate cancer staging.
- Creation of a planned urinary diversion to restore urinary drainage.
- Potential improvement in long-term cancer control.
- May enhance survival in patients with localised disease.
When Is Open Radical Cystoprostatectomy & Urethrectomy Recommended?
A specialist may recommend this procedure in the following situations:
- Muscle-invasive bladder cancer.
- High-risk non-muscle-invasive bladder cancer that has not responded to other treatments.
- Bladder cancer involving the urethra.
- Recurrent bladder cancer unsuitable for bladder-preserving therapy.
- Multifocal tumours affecting the bladder and urethra.
- Selected cases of locally advanced bladder cancer.
- Patients who are medically fit for major surgery and curative treatment.
What Does Preparation for Open Radical Cystoprostatectomy & Urethrectomy Involve?
Preparation begins with a comprehensive medical assessment, including a physical examination, blood tests, urine tests and imaging studies such as CT or MRI scans to determine the extent of the cancer. Cystoscopy and biopsy findings are reviewed to confirm the diagnosis and guide treatment planning.
Patients also undergo assessment of heart and lung function to ensure they are fit for major surgery. The surgeon discusses urinary diversion options, including an ileal conduit or continent diversion, so patients understand life after bladder removal. Pre-operative counselling, nutritional advice and smoking cessation are encouraged where appropriate. Patients receive instructions regarding fasting, medication adjustments and bowel preparation if required before the operation.
How Is Open Radical Cystoprostatectomy & Urethrectomy Performed?
The operation is performed under general anaesthetic through an incision in the lower abdomen. The surgeon first carefully exposes the pelvic organs before removing the bladder, prostate gland, seminal vesicles and the entire urethra. Nearby lymph nodes are usually removed to assess whether the cancer has spread and to improve cancer staging.
After removing the affected organs, the surgeon creates a urinary diversion to allow urine to drain from the kidneys. This commonly involves using a short section of the small intestine to construct an ileal conduit, which directs urine through a stoma into an external collection bag. In selected patients, a continent urinary diversion may be created instead.
Throughout the procedure, meticulous attention is paid to controlling bleeding and protecting surrounding structures where possible. Once the urinary diversion is completed and checked for proper function, surgical drains may be placed, and the abdominal incision is closed with sutures or staples before the patient is transferred to the recovery area.
What to Expect during Recovery after Open Radical Cystoprostatectomy & Urethrectomy?
Recovery usually involves several days in hospital. Patients receive pain relief, intravenous fluids and early physiotherapy to encourage mobilisation and reduce the risk of complications. The healthcare team monitors wound healing, bowel function and the urinary diversion. Patients are taught how to care for their stoma or continent reservoir before discharge. Fatigue is common for several weeks, and most patients gradually resume normal activities over six to twelve weeks. Regular follow-up appointments are essential to monitor recovery, urinary function and cancer surveillance.
What Are the Risks and Complications of Open Radical Cystoprostatectomy & Urethrectomy?
As with any major cancer surgery, potential risks and complications include:
- Bleeding requiring transfusion
- Infection
- Blood clots
- Wound healing problems
- Injury to nearby organs or blood vessels
- Urinary diversion or stoma-related complications
- Bowel obstruction or leakage
- Sexual dysfunction and infertility
- Lymphatic fluid collection (lymphocele)
- Cancer recurrence or the need for additional treatment