Cystoprostatectomy is a type of surgery to treat bladder cancer in men. It involves removing both the bladder (called a cystectomy) and the prostate gland (prostatectomy) in men who have cancer that has spread to the muscles in the wall of the bladder.
Often, surgeons also take out the seminal vesicles (glands located behind the bladder that help produce semen) and lymph nodes in the pelvis.
In very rare cases, surgeons might perform a cystoprostatectomy to treat prostate cancer that has moved into the bladder, says Roger Li, MD, a genitourinary oncologist at Moffitt Cancer Center in Tampa, Florida.
The urinary system is closely connected with the prostate gland. The prostate is located just below the bladder and wraps around the urethra, which is the tube that sends urine from the bladder to the penis.
Prostate cancer affects non-Hispanic Black men more than other groups. Non-Hispanic white men are more likely to get bladder cancer. But Black men have the poorest survival rate from it. Both are more common in older men.
Types of Cystoprostatectomy
A cystoprostatectomy involves two stages, says Lee Richstone, MD, chair of urology at Lenox Hill Hospital in New York City. The first is the removal of the bladder and prostate (and any surrounding structures, if needed). The second is the rebuilding of the urinary system (also called urinary diversion). That is done so you can still pee after the bladder has been removed. The two stages happen during the same operation. There are different ways to do each.
Your doctor may pick one of these ways to remove your bladder and prostate:
- Open cystoprostatectomy. This operation is done with one large, open incision in the abdomen, Richstone says. This is the common way to do the procedure. A lot of doctors still do it this way.
- Laparoscopic cystoprostatectomy. Laparoscopic surgery involves making several small cuts (as long as 1 centimeter each). Then the doctor inserts a special camera, so they can see what they’re doing, and instruments to remove the organs. In general, there is less pain and less scarring than with an open procedure. Recovery time usually is quicker, too.
- Robot-assisted laparoscopic cystoprostatectomy. This is similar to regular laparoscopic surgery, but with robotics added. “It simplifies the procedure technically and is more ergonomic for the surgeon,” Richstone says. Research shows this type of surgery lowers the amount of blood lost. And you generally won’t spend as much time in the hospital.
Types of Reconstruction Operations
Next, your doctor will do one of three types of urinary reconstruction surgery:
- Ileal conduit. This is the simplest type of reconstruction and the most common. It uses about 15 centimeters of the small intestine (the ileum) to create a passage connected to the ureters (the tubes carrying urine from the kidneys to the bladder). The surgeon then sews the passage (called a conduit) to the abdominal wall so urine can drain from the kidneys through the ureters into an external bag, Richstone says. The area where the passage reaches the surface of the skin is called a stoma. “It is pink and fleshy like the inner part of the mouth and about the size of a quarter dollar or half dollar,” he says.
- Continent cutaneous urinary diversion. This operation is more complicated and involves making an internal pouch out of part of the intestine, usually the large bowel. “The pouch receives the urine from the kidneys and is brought up to the skin of your body to a stoma or sphincter that is about the size of a dime,” Richstone says. The urine does not automatically drain out of the body. Instead, “the patient has to insert a catheter or small tube in order to drain the fluid from the inside,” Li says. The advantage is you don’t need a bag. The downside is that patients sometimes need more surgery to tighten the sphincter mechanism, Richstone says.
- Orthotopic ileal neobladder. This involves using a piece of your intestine to create a new “bladder.” This structure is placed in the pelvis and connected to the ureters, making it possible for you to urinate through the urethra, Li says. The risk of urine leakage is great, especially at night. Some men have the opposite problem, which is trouble emptying the bladder completely, Richstone says.
How Effective Is a Cystoprostatectomy?
Once the cancer has reached the muscle of the bladder walls, it is considered invasive, Li says. This means recovery and survival rates are likely to be lower than if the cancer had not spread beyond its first site.
The prognosis for people with bladder cancer who have had a cystoprostatectomy depends on many factors, but the 5-year survival rate is still relatively good, an estimated 60% to 70% overall, Li says. If the cancer is found outside the bladder, that number drops to about 50%. If the lymph nodes are involved, it drops again to about 30%, he adds.
In general, your prognosis is better when the cystoprostatectomy is performed by experienced surgeons at “high-volume” centers (those that do many procedures), Li says. There are four or five different centers in the U.S., Moffitt being one of them, which performs about 150 to 200 cystectomies a year, Li says. This includes both women and men, though females do not have the “prostatectomy” part of the operation.
What to Expect From a Cystoprostatectomy
If cancer has spread to the walls of the bladder, doctors typically recommend chemotherapy before surgery to slow cancer growth. Research has shown that this can improve survival rates. So can additional chemotherapy after the cystoprostatectomy.
The operation itself is performed in the hospital under general anesthesia and can last 4-6 hours. “We try to get patients out of the hospital in 5 to 7 days, while recovery takes 4 to 6 weeks,” Richstone says.
Patients also get counseling from a nurse to learn how to operate the new urinary diversion mechanism, he adds.
What Are Possible Complications of Surgery?
Because a cystoprostatectomy is such a complicated procedure, things can go wrong. The chances of developing a complication in the first 90 days after surgery approaches 50%, Richstone says.
But a large number of those are mild or moderate and can be managed, he adds. Such complications might include:
- Urine blockages
You might get blood clots, but these can be prevented with compression stockings and blood-thinning medications.
Given that the nerves that are involved with erections are next to the prostate and bladder, men can lose some sexual function after having a cystoprostatectomy. Depending on how far the cancer has spread, experienced surgeons may be able to perform “nerve-sparing” surgery to keep the ability to get an erection, Richstone says.
The risk of death is approximately 2% to 3%, Li says.