Partial cystectomy is a cancer operation in which the section of the bladder containing a tumour is removed with a margin of healthy tissue, while the rest of the bladder is preserved. When suitable, it avoids removal of the whole bladder (radical cystectomy) and the need for a urinary diversion. However, it is only appropriate for a small, carefully selected group of patients in whom the tumour can be completely removed with clear margins.
In suitable patients the operation can be performed robotically through keyhole incisions, the pelvic lymph nodes are usually removed at the same time, and chemotherapy before surgery is considered for muscle-invasive disease. Radical cystectomy and radiotherapy-based bladder preservation remain the standard treatments for most muscle-invasive bladder cancers, and we discuss all options with you.
For benign (non-cancerous) bladder pouches, see our separate Bladder Diverticulectomy page.
TREATMENTS
Partial Cystectomy
When Is Partial Cystectomy Considered?
Partial cystectomy is considered in three main situations, always after staging investigations and multidisciplinary review:
• Highly selected muscle-invasive bladder cancer: a solitary tumour in a favourable position, typically at the bladder dome with no other concerning features
• Urachal cancer: a rare cancer arising in the urachus (a remnant that runs from the bladder dome to the belly button).
• Cancer within a bladder diverticulum: because a diverticulum has little muscle in its wall, a tumour inside may be treated by removing the entire diverticulum with a cuff of surrounding bladder, and can often be done robotically.
How the Operation Is Performed
• Robotic keyhole surgery: through small incisions, the tumour-bearing segment of the bladder is removed full thickness with a healthy margin and the bladder is repaired with dissolving sutures, with open surgery used where it is more appropriate.
• Pelvic lymph node dissection: the lymph nodes that drain the bladder are removed at the same time for accurate staging and treatment.
• Urachal excision: for urachal cancer, the bladder dome, urachal tract and possibly the umbilicus are removed together.
The bladder holds less urine immediately after surgery and capacity usually improves over the following months, although some patients notice they pass urine more often in the long term.
Risks and Considerations
All procedures carry risks, which your surgeon will discuss with you in detail. These may include:
• Recurrence of cancer in the preserved bladder, which is why lifelong cystoscopy surveillance is essential and some patients later need removal of the whole bladder (completion cystectomy).
• Cancer at or close to the margins on final pathology, which may lead to a recommendation for further surgery or other treatment.
• Urine leak from the bladder repair.
• Reduced bladder capacity with more frequent urination, occasionally long term.
• Injury to the ureters or bowel, or temporary slowing of the bowel (ileus).
Recovery at a glance: Most patients stay 2-4 nights in hospital and go home with a catheter for about 1 - 2 weeks, which is removed once an X-ray confirms the bladder has healed, with most people back to normal activities by 4-6 weeks.
1
Staging and Selection
CT and possibly MRI scans, cystoscopy and biopsy map the tumour and exclude other disease or risk factors.
2
The Operation
The tumour-bearing segment is removed with a healthy margin, usually robotically, together with a pelvic lymph node dissection, and for urachal cancer the urachal tract and possibly umbilicus are also removed.
3
Recovery and Catheter Care
You go home with a catheter while the bladder repair heals, and a cystogram confirms healing before the catheter is removed.
4
Lifelong Surveillance
Regular cystoscopy checks of the preserved bladder, urine tests and periodic scans continue as new tumours may develop years later.
Our Approach
