A radical cystectomy is the complete surgical removal of the bladder. It can be thought of as three separate procedures: (1) removal of the bladder, (2) removal of the lymph nodes, and (3) creation of a bladder substitute. When performed for bladder cancer in men, it usually includes removal of the prostate, seminal vesicles, and a portion of the vas deferens. When performed for bladder cancer in women, it usually includes removal of the uterus and cervix as well as the urethra, although the ovaries may be left in place. The urethra is removed in men only if the bladder cancer extends into it. Another important part of the operation is called the pelvic lymph node dissection.
This part of the procedure removes the lymph nodes through which the bladder drains. Remember that these lymph nodes are usually the first places where bladder cancer spreads. Taking the lymph nodes out allows us to do two things. First, looking at the lymph nodes under the microscope can tell us whether the cancer has spread outside of the bladder. Knowing this helps us predict the likelihood of the cancer coming back as well as helps to direct any treatment in the future. Second, if the lymph nodes are the only place to which the cancer has spread, then removing the affected nodes may in fact cure you. For this reason, it is extremely important to have a thorough lymph node dissection performed.
Finally, remember that after the bladder is removed, your body still needs to store and drain the urine that it makes. The last part of the operation creates this new route for the urine. Several different options are available, and you should discuss with your surgeon beforehand which one is right for you.