Information for patients
After your surgery
Not all patients will have the same experience, but most patients remain in hospital for between 8 and 14 days. A delay in recovery time is usually related to slow bowel activity.
Patients who have neo-bladder generally return home before being readmitted to have their new bladders activated. This requires an overnight stay and occasionally the bladder is activated in the early phase after the main cystectomy procedure. Patients traveling from overseas generally remain in the UK for four weeks before returning home.
New therapies for non-muscle invasive bladder cancer
John leads clinical research to develop new therapies and innovative chemotherapy applications for bladder cancer. These treatments hold great promise to reduce recurrence of cancer and improve outcomes for patients.
John is the chief investigator for two large clinical trials investigating how adding heat (hyperthermia) to chemotherapy affects treating bladder cancer. The aim of these studies is to understand if hyperthermia enhances the effect of chemotherapy to reduce recurrence of disease. So far, the trials have indicated that “hyperthermic mitomycin” can be an alternative to BCG therapy and can be used to treat some patients whose bladder cancer recurs following BCG.
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Find out more about Professor Kelly’s clinical research studies
Neobladder or ileal conduit?
The decision to have a neo-bladder or ileal conduit depends on a number of factors including the type of cancer and its location within the bladder. Your age, gender and personal preference also have a role to play.
In helping you come to a decision, we try to match new patients with another patient (of the same gender and of a similar age to you) who has been through the experience of having a robotic cystectomy and urinary diversion. Sharing the experience and understanding the pros and cons of urinary diversion is key to informed decisions and successful outcomes.
We will provide written information to help you make a decision and you will be supported by our clinical nurse specialists (CNS).
Restoration of sexual function is an important factor in making a decision. Studies show that this issue is frequently not addressed for patients with bladder cancer. For some patients it is not possible to preserve the nerves that enable normal sexual function. For example, the stage and location of the cancer can impact on the decision to attempt to spare the nerves. In addition to nerve sparing cystectomy operations we work with other specialists to offer an erectile recovery programme for men.
Risks of robotic surgery
All surgery carries a risk. Even with robotic techniques the procedure of cystectomy is a major operation and careful operative planning and post-operative care are important to reduce complications. Your surgeon’s experience and expertise, regardless of technique, are key factors for a successful operation.
Female patients and robotic cystectomy
The incidence of bladder cancer is lower in females than males, but in the group of females undergoing cystectomy there are important things to consider.
This type of surgery often removes the front part of the vagina. Vaginal sparing and vaginal reconstruction surgery should be performed for patients of all ages who are sexually active.
Restoration of the pelvic anatomy following surgery is especially important for patients who have bladder reconstruction. Following a radical cystectomy the pelvic floor can become weakened and this impacts on your ability to control urine.
In female patients who have a neo-bladder the problem can become an inability to pass urine spontaneously. New techniques to reduce the need for bladder catheterisation are being developed.
Urinary diversion
If your bladder is being removed you will need an alternative way for urine to leave your body. This is called “urinary diversion” and either involves forming an opening in the lower abdominal wall for urine to drain out into a bag (called an “ileal conduit”) or by reconstructing a new bladder (called a “neo-bladder”).
Some surgeons convert to an open surgery when performing urinary diversions, however this means losing the benefits of keyhole surgery. John is an expert robotic surgeon and has developed techniques to reconstruct the bladder without having to convert from robotic to open surgery.
Although John has spent many years performing cystectomies using open surgery, he now chooses to perform cystectomy robotically with ileal conduit or neo-bladder as the standard approach.
Treating non-muscle invasive bladder cancer
If you have been diagnosed with non-muscle invasive bladder cancer, the aim of treatment is to reduce likelihood of the cancer returning and to prevent it moving beyond the lining of your bladder.
Your treatment recommendations will depend on how likely your cancer is to return. Once the bladder tumour has been removed you will have regular bladder checks called surveillance cystoscopy. In addition, treatments such as chemotherapy (usually a drug called mitomycin) or immunotherapy (such as BCG vaccine) can be administered directly into the bladder. This form of treatment is called intravesical therapy.
A transurethral resection of a bladder tumour (or TURBT) is a surgical treatment to remove bladder tumours. During the operation the tumour (or tumours) are cut away from the bladder wall, removed and then sent for examination. From this, your consultant will be able to find out whether the tumour cells are cancerous. If they are found to be cancerous, we will be able to tell how severe the cancer is.
The procedure is performed using a specially designed instrument which is passed along the water pipe (or urethra) and does not involve a skin incision. The information received from the path lab can then be used to help decide any future treatment.
Many patients with superficial bladder cancer will experience a recurrence of cancer. For patients at intermediate or high risk of recurrence, it is recommended to have either chemotherapy or immunotherapy after the tumour has been removed.
We are exploring how to improve current treatments, for example using chemotherapy hyperthermia and novel agents which may be more effective than standard chemotherapy.
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Find out more about Professor Kelly’s clinical research
Treating muscle invasive bladder cancer
Muscle invasive bladder cancer is when the cancer has moved beyond the lining of the bladder and can no longer be reliably removed by transurethral resection (TURBT). In such cases we aim to get rid of the cancer completely by removing the bladder (called “cystectomy”). This type of treatment is described as “radical treatment”.
This type of treatment may have an impact on your lifestyle, sexuality, emotions and body image. John will take these factors into consideration before discussing your options in full and making any recommendations.
Robotic cystectomy
John performs cystectomy operations laparoscopically (key-hole technique) using robotic surgery.
Robotic cystectomy combines the benefits of keyhole surgery and the precision of cutting edge robotic technology to remove the bladder.
The surgeon controls keyhole instruments to make very fine movements with great dexterity under 3D magnified vision. Removing the bladder in this way has advantages, such as reduced recovery time and far less visible scarring.
Bladder cancer develops when a growth of abnormal tissue, known as a tumour, develops in the lining of the bladder. In some cases, the tumour can spread into surrounding tissues.
The most common symptom of bladder cancer is haematuria (blood in your urine). Other less common symptoms include a sudden urge to urinate and a burning sensation when passing urine.
Bladder cancer can be “non-muscle invasive” (sometimes called superficial cancer) - this is when only the inner lining of the bladder is affected by cancer. When cancer has moved into the muscle wall of the bladder, it is called “muscle-invasive” bladder cancer.