Surgery is the main treatment for most cases of bladder cancer. The specific procedure your doctor recommends will depend on the extent and grade of the cancer. In general, early stage bladder cancer requires less extensive surgery than later stages. However, doctors sometimes need to perform more extensive surgery even on early tumors. This may be the case if there are multiple tumors or if the tumor is large or likely to recur. Learning about the different procedures and possible reconstructive surgeries will help you and your care team decide on a treatment plan and allow you to plan for recovery. Transurethral Resection of Bladder Tumor (TURBT) TURBT is the most common method of treating early tumors, especially those confined to the lining of the bladder. Some people need additional treatment after TURBT with intravesical therapy. Doctors also use TURBT to remove a tissue sample (biopsy) from the tumor before treatment. A pathologist analyzes the tumor cells from the biopsy and stages the cancer. This helps your care team plan the most appropriate treatment. TURBT does not require an incision. It involves inserting a cystoscope—a tube-shaped device—into your urethra all the way to the bladder. Your doctor will guide surgical instruments through this tube to the tumor inside the bladder and remove it. You will receive an anesthetic to keep you comfortable during the procedure. Side effects with TURBT tend to be mild and short-lived. Blood in the urine and pain with urination are the most common problems after TURBT. This usually resolves within a few days and most people return to their normal activities in about a week. Partial Cystectomy Cystectomy is a medical term for removing part or all of the bladder. Partial cystectomy may be an option for tumors that have grown into the muscle layer of the bladder. Doctors may recommend the procedure if the tumor is small and affects only one area of the bladder wall. Partial cystectomy requires an incision in your abdomen. It involves removing part of the bladder wall, including the tumor and some healthy tissue surrounding it. Your surgeon will close the resulting hole, which makes the bladder smaller than before surgery. You may have an option of minimally invasive (laparoscopic) partial cystectomy. Your surgeon performs the operation through several small incisions in your abdomen instead a single larger incision. You will receive a general anesthetic for either procedure. The main side effect of this surgery is a more frequent need to urinate due to the reduced bladder size. You will spend some time in the hospital after a partial cystectomy and return to normal activities within a few weeks. Radical Cystectomy Radical cystectomy is necessary for large tumors and when tumors affect more than one area of the bladder wall. It is the most common procedure for stage II and later stages of bladder cancer. Radical cystectomy also requires an incision—either traditional or laparoscopic—in your abdomen. It involves removing the entire bladder and some of the urethra. This means reconstructive surgery will be necessary. The surgeon also removes nearby lymph nodes to check them for cancer. In addition, your surgeon may need to remove nearby reproductive organs. For men, this can include the prostate and seminal vesicles. In women, it can include the ovaries, fallopian tubes, uterus, cervix, and even the upper part of the vaginal canal. Like partial cystectomy, you will be under general anesthesia for the procedure. You will spend up to a week in the hospital after radical cystectomy and return to normal activities within several weeks. Reconstructive Surgery Before radical cystectomy, you and your surgeon will discuss your options for reconstructive surgery. These surgeries create a new way to store urine and eliminate it from the body. Part of the discussion will include how each of the procedures affects your everyday life. Your care team will educate you and offer nursing support as you transition to a new way of eliminating urine. Reconstructive surgery options include: Incontinent diversion, the simplest form of reconstruction. It connects a piece of intestinal tissue to the ureters—the tubes that carry urine from the kidneys to the bladder. The other end of the intestinal tissue connects to an opening in your abdomen. Urine flows through this new connection and collects in a pouch outside your body. You empty the pouch once it is full. Continent diversion, which uses intestinal tissue to create a pouch inside your body to collect urine. The pouch connects to an opening in your abdomen with a valve. You insert a catheter through the valve several times a day to empty the urine. There is no pouch or bag outside your body with this technique. Neobladder, which also uses intestinal tissue to create a pouch inside the body. The surgeon connects the pouch to the urethra instead of an abdominal opening. One the tissue heals, a neobladder will eventually allow you to urinate normally during the day. However, you may still experience incontinence during the night. Radical cystectomy usually involves prostate removal, or prostatectomy, for men. The main side effect of this procedure is erectile dysfunction (ED). Almost all men will have some difficulty achieving an erection after prostate removal. Talk with your doctor about effective ED treatments. For women, the side effects will depend on which organs the doctor removes. Removing the ovaries can cause menopausal symptoms in women who have not gone through menopause. Ask your doctor what to expect with your specific type of surgery. It can be difficult to make treatment decisions in the face of cancer. But, having information about bladder cancer surgery and its side effects can help you choose what is right for you and prepare for potential lifestyle changes after treatment.