Surgery for metastatic bladder cancer
Metastatic bladder cancer means that your cancer has spread to another part of your body. It is also called advanced cancer.
You might have surgery to:
- remove the cancer from your bladder - this is called TURBT
- unblock your ureters or kidneys - the ureters are the tubes that connect your kidneys to your bladder
The aim of surgery for advanced cancer is to relieve your symptoms. So it is important that the benefit is greater than the side effects of having the operation. Your doctor will talk this through with you when deciding about treatment.
We have a separate section about surgery to remove your bladder (cystectomy) for cancer that hasn't spread. Usually, the aim of a cystectomy is to try and cure your cancer. This surgery isn't usually an option for metastatic bladder cancer.
Surgery to remove cancer from the bladder
Your doctor might suggest removing cancer from your bladder. The aim is to stop any bleeding and slow down the cancer. This is called debulking. The operation is called a trans urethral resection of bladder tumour (TURBT).
How you have it
Doctors remove cancer in the bladder using a thin tube called a cystoscope. You have it while you are asleep (general anaesthetic). You’ll get information about when to stop eating and drinking before your operation.
The surgeon puts the cystoscope into the tube where your urine comes out (your urethra). The cystoscope has optic fibres inside it, a light, camera and eyepiece at one end. The surgeon can look through the eyepiece or see images on a TV screen.
The surgeon passes instruments down the cystoscope. They remove as much of the cancer as possible.
When you wake up you have a thin tube in your bladder called a catheter. This drains urine out of your bladder into a bag. Your catheter might also have a flushing system (irrigation) attached. This flushes out any blood clots that may form in the bladder after your surgery.
You might have some bleeding for a couple of days. Once the bleeding stops your nurse removes the irrigation and takes the catheter out.
You can read more about having TURBT in the section about non muscle invasive bladder cancer.
Surgery to unblock the ureters or kidney
Cancer can block the tubes that connect your kidneys to your bladder (ureters). Or it can block the kidney itself. This can make urine build up in the kidney and stop it from working properly.
Your doctor might suggest an operation to relieve the blockage and to help the kidney work again. This can relieve symptoms. And by improving your kidney function, it might mean that you are able to have chemotherapy.
Usually the doctor uses an X-ray to guide them to the blockage during the procedure.
How you have it
Your doctor passes a small thin telescope through your urethra. This is the tube where your urine comes out of your body. The telescope goes into your bladder to where the blockage is. They then place the small tube (a stent) to allow your urine to drain. This means you won’t have a wound afterwards.
Or you may have a tube (a nephrostomy tube) through your skin to collect urine on the outside of your body. Doctors use this for a blocked kidney. You have an injection to numb the area (local anaesthetic) where the tube comes out.
Follow up
At your follow up appointment, your doctor:
- gives you the results of the surgery
- examines you
- asks how you are and if you've had any problems
This is also your opportunity to ask any questions. It's useful to write down any questions you have beforehand to help you remember what to ask. Taking someone with you can also help you to remember what the doctor says.
You continue to have regular check ups with your doctor or nurse to see how you’re doing. They can also help with any new symptoms or side effects of treatment.
You’ll get the contact details of a specialist nurse if you have any questions between the surgery and your appointment.
