Metastatic Bladder Cancer: Surgeries to Know About

For metastatic bladder cancer, surgery can help control symptoms such as pain, bleeding, or urinary obstruction, says Nitin Yerram, MD, a urologic oncologist and the codirector of urologic oncology at Hackensack Meridian John Theurer Cancer Center in New Jersey.

Below, learn the types of surgery used to treat metastatic bladder cancer.

The removal of your bladder tumor can help you live longer and make other treatments like chemotherapy more effective, says Yerram. “Surgery [also] allows for a direct examination of the tumor tissue, providing a more accurate assessment of how well chemotherapy has worked compared to imaging alone.”

• Bleeding
• Wound infection
• Blood clots
• Rare reactions to anesthesia

But once your procedure is over, your care team will tell you what side effects to watch for and what to expect as you recover.

• Nephrostomy This is a tube that drains urine from your kidney through a hole in your back into a collection bag.
• Urostomy This involves a surgeon creating a passage for urine using a piece of your intestine or by bringing the ureters, the tubes that carry urine from the kidneys to the bladder, out through the skin to drain into a bag.
• Bladder Substitute A surgeon creates a replacement bladder from a piece of your intestine, allowing you to hold your urine and go to the bathroom when needed.

A radical cystectomy can increase survival time and remove the main source of your tumor, says Yerram. “The removal and examination of the bladder and nearby lymph nodes [also] provide crucial information about the extent of the cancer, which can help guide further treatment.”

• Nearby organ damage
• Erectile dysfunction
• Vaginal discomfort during sex
• Sexual arousal difficulty

A metastasectomy involves the surgical removal of one or more metastatic tumors from other parts of your body, like the lungs or lymph nodes, says Yerram. The goal of this type of surgery is to take out any tumors growing separately from the main bladder tumor.

• Pneumonia
• Breathing problems
• Heart attack
• Kidney failure

Sexual dysfunction may also result, such as the following:

• A reduced ability for men to achieve and maintain erections
• Increased discomfort during sex after the removal of part of the vagina in women
• A negative impact on a woman’s ability to have an orgasm due to damage in the nerve bundles along each side of the vagina
• Reduced blood supply to the clitoris if a surgeon removes the end of the urethra, possibly affecting sexual arousal

But newer surgical techniques can reduce the impact of the procedure on penile erections, and reconstructive surgeries are available to rebuild the vagina. Some surgeries can also spare the nerves linked to female orgasms. Discuss the available options with your cancer care team.

You don’t have to decide on surgery for metastatic bladder cancer by yourself. “Your medical team can help you understand all your options,” advises Yerram. “The decision about whether surgery is the right next step for you is not a simple yes or no — it's a highly personalized choice that depends on many factors.”

• Your overall health
• The location and number of metastatic tumors
• Your response to other treatments

Always ask if you could be eligible for any clinical trials. These are research studies that test new treatments or new ways of using existing treatments, says Yerram. “For metastatic bladder cancer, there is a great deal of research into new drug combinations, immunotherapies, and the optimal timing of surgery.”

Participating in a trial could give you access to a cutting-edge therapy that a healthcare provider may not offer you otherwise, says Yerram.

• Surgery for metastatic bladder cancer can support other treatments, improve survival time, and lessen symptoms like painful urination or blood in your urine.
• Metastatic bladder cancer surgical treatment options include bladder and lymph node removal (radical cystectomy), the removal of other tumors in the body, and procedures to rebuild a way for your urine to leave your body (urinary diversion).
• To work out whether surgery is right for you, you can ask your doctor, who may meet with other specialists to help you decide on the best surgical treatment path.