Bladder removal

Radical cystectomy means removal of the bladder. Treatment planning includes both how the bladder is removed and how urine will be diverted afterwards. Open and robot-assisted surgery are two approaches. Urinary reconstruction is a separate choice: a neobladder is a reconstructed urinary reservoir. For robot-assisted surgery, the choice of a neobladder depends on cancer safety, physical function, kidney function and your preferences. A 2026 expert consensus also supports assessing frailty and nutrition before surgery and considering nerve-preserving approaches in selected patients to help protect urinary control and sexual function.

Bladder removal is used for bladder cancer that has grown into the bladder muscle, and for selected high-risk or recurrent cancers that have not invaded the muscle. In women, preserving pelvic reproductive organs while removing the bladder is a distinct surgical option studied in these settings; it does not mean preserving the bladder itself.

Open and robot-assisted bladder removal are alternative surgical approaches. A 2026 review compared them in five randomized trials involving 541 adults with bladder cancer: 271 had robot-assisted surgery and 270 had open surgery. In both groups, urinary reconstruction was performed outside the body. Overall and major complication rates within 90 days did not show a clear difference. These findings apply to that reconstruction technique, not automatically to every form of robotic surgery.

The hospital’s experience is one consideration when choosing where to have bladder removal. A 2020 review included 39 retrospective studies involving 549,542 patients who had radical cystectomy for bladder cancer. Hospitals performing more of these operations generally had better outcomes, including lower death rates during the hospital admission and within 30 and 90 days. The guideline panel recommended hospitals perform at least 10, and preferably more than 20, radical cystectomies each year, or refer patients to a centre reaching that volume. These observational findings do not establish a personal survival prediction, and evidence about individual surgeon volume was limited and conflicting.

Urinary tract infection is an important risk after bladder removal. A 2026 review pooled 17 observational studies involving 18,976 patients who underwent radical cystectomy. Within 90 days of surgery, the estimated infection rate was 21 in 100 patients, with a statistical uncertainty range of 17 to 25 in 100. Among patients who developed a urinary infection, about 25 in 100 developed urosepsis, a serious whole-body response to a urinary infection; the uncertainty range was 19 to 32 in 100. That second figure refers to patients with an infection, not everyone having surgery. Reduced kidney function and a neobladder were among the factors associated with greater infection risk.

Enhanced recovery after surgery is a structured care pathway around the operation. A 2026 review compared this pathway with usual care after robot-assisted bladder removal in four studies involving 473 patients: 251 received enhanced recovery care and 222 did not. Hospital stays were about 3.1 days shorter on average with enhanced recovery care; this is a difference between groups, not the total expected stay. Bowel function returned sooner, and fewer overall complications were recorded within 30 days, but there was no clear difference in overall complications within 90 days.

Preparation for robot-assisted surgery includes assessment of nutrition and frailty. After bladder removal and urinary reconstruction, ongoing care also needs to consider kidney function. The choice of urinary reconstruction takes account of other illnesses and the need for close monitoring after surgery.