Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 11 June 2026
Robotic radical cystectomy is the gold-standard surgical treatment for muscle-invasive bladder cancer and for selected high-risk non-muscle-invasive disease. It involves removing the entire bladder and creating a new way for urine to leave the body — either through an ileal conduit (a stoma on the abdomen) or a neobladder (an internal pouch reconstructed from bowel and joined to the urethra).
This guide explains, in plain English, what to expect before, during and after robotic radical cystectomy in Melbourne with Dr Brendan Dias, including the differences between the two main diversion options and where to find local stoma and ostomy support in Victoria.
Who Needs a Radical Cystectomy?
Radical cystectomy is generally recommended for patients with:
- Muscle-invasive bladder cancer (clinical stage T2 or higher) confined to the bladder or pelvis
- High-risk non-muscle-invasive bladder cancer (e.g. high-grade T1, carcinoma in situ) that has not responded to BCG bladder instillations
- Recurrent high-grade tumours not controllable with endoscopic resection
- Selected cases of extensive papillary disease or symptomatic bladder dysfunction from prior treatment
Every case is reviewed in a multidisciplinary team (MDT) meeting with medical oncology, radiation oncology and radiology. Many patients benefit from neoadjuvant chemotherapy (cisplatin-based) before surgery, which has been shown to improve long-term survival.
Why Robotic Surgery?
Compared with traditional open cystectomy, the robotic approach using the da Vinci surgical system offers:
- Smaller incisions — typically six 8–12 mm port sites and a small extraction incision
- Less blood loss and reduced transfusion requirement
- Faster return of bowel function and earlier mobilisation
- Shorter hospital stay when combined with an Enhanced Recovery After Surgery (ERAS) pathway
- Equivalent oncological outcomes to open surgery in randomised trials (RAZOR, iROC)
Dr Dias performs the entire procedure — including the urinary diversion — using a totally intracorporeal robotic technique, which avoids the larger midline incision used in older "extracorporeal" approaches.
Before Surgery: Preparation
- MDT review and staging — CT chest/abdomen/pelvis, often MRI pelvis, and sometimes a PET scan
- Anaesthetic and fitness assessment — including cardiac/respiratory work-up and prehabilitation where appropriate
- Stoma nurse consultation — essential if an ileal conduit is planned, to mark the best stoma site on your abdomen
- Counselling on diversion choice — discussion of ileal conduit vs neobladder, including impact on lifestyle, sexual function and follow-up
- Carbohydrate loading and bowel preparation — as per the ERAS protocol on the day before surgery
The Operation Step by Step
1. Robotic Radical Cystectomy
Under general anaesthesia, six small ports are placed in the abdomen. The bladder is mobilised, the ureters are divided, and the bladder is removed together with the prostate and seminal vesicles in men, or the uterus, ovaries and anterior vaginal wall in women where indicated. An extended pelvic lymph node dissection is performed to remove lymph nodes up to the aortic bifurcation, which both stages and treats the disease.
2a. Robotic Intracorporeal Ileal Conduit Creation
The most common urinary diversion worldwide. A 15–20 cm segment of small bowel (ileum) is isolated, the remaining bowel is rejoined, and the ureters are stitched into one end of the bowel segment. The other end is brought through the abdominal wall to form a stoma, over which a discreet collection bag (ostomy appliance) is worn. Urine drains continuously into the bag, which is emptied several times a day.
The conduit is technically straightforward, has a shorter operating time, fewer late metabolic complications and is suitable for almost all patients including those with reduced kidney function or who are less mobile.
2b. Robotic Intracorporeal Neobladder Creation
For selected, fit patients who want to avoid an external bag, a neobladder can be constructed instead. A longer segment (about 40–60 cm) of ileum is taken, opened along its length and folded into a low-pressure spherical pouch (commonly a Studer or modified U-shaped configuration). The ureters are implanted into the pouch and the lowest point is joined to the urethra, so urine drains through the urethra in a more natural way.
Suitable candidates are typically younger, motivated patients with:
- Good kidney and liver function
- No cancer involvement at the bladder neck or urethra
- No inflammatory bowel disease or previous extensive bowel surgery
- Capacity to learn timed voiding and, if needed, intermittent self-catheterisation
Ileal Conduit vs Neobladder — Side-by-Side
| Factor | Ileal Conduit | Neobladder |
|---|---|---|
| External bag | Yes — worn over stoma | No — passes urine via urethra |
| Operating time | Shorter | Longer (1.5–2 hours more) |
| Hospital stay | 5–7 days | 6–9 days |
| Continence | Continuous drainage into bag | Day continence 80–90%; night continence 60–70% |
| Self-catheterisation | Not required | May be required (≈20% of patients) |
| Suitable kidney function | Wide tolerance | Needs eGFR > 45–50 |
| Long-term follow-up | Stoma care, B12, electrolytes | Voiding training, B12, metabolic monitoring |
Hospital Stay and Enhanced Recovery (ERAS)
- Day 0 (operation day) — surgery typically takes 5–7 hours; sips of clear fluids the same evening
- Day 1–2 — out of bed, walking with assistance, light diet introduced, epidural or local anaesthetic catheters managed
- Day 3–4 — bowel function returns, drains and epidural removed, stoma training begins with the stomal therapy nurse
- Day 5–8 — discharge home with ureteric stents (removed at 2–3 weeks) and, for neobladder patients, an indwelling catheter for 2–3 weeks
Recovery at Home
- Weeks 1–2 — gentle walking, no driving, stoma nurse home visits and bag changes
- Weeks 3–4 — stents removed, energy levels improving, light activities resumed
- Weeks 4–6 — return to desk work and most non-strenuous activities; neobladder patients begin pelvic floor and voiding training
- 3 months — most patients close to normal activity; first surveillance CT
- Long-term — life-long oncological follow-up with imaging, blood tests (including vitamin B12 and bicarbonate) and review of the diversion
Risks and Complications
Radical cystectomy is a major operation. The 90-day complication rate is around 30–60% in published series, most of which are minor (Clavien I–II) and managed without further surgery. Important risks include:
- Bleeding, infection (wound, urinary tract, chest), blood clots (DVT/PE)
- Ileus or slow return of bowel function
- Ureteric or bowel anastomotic leak
- Stoma complications (retraction, parastomal hernia, skin irritation)
- Neobladder-specific: incontinence, urinary retention requiring self-catheterisation, metabolic acidosis
- Sexual dysfunction — erectile dysfunction in men, vaginal dryness or dyspareunia in women
Ostomy & Stoma Support in Victoria and Melbourne
For patients having an ileal conduit, ongoing support from a stomal therapy nurse and an ostomy association is invaluable. The following organisations provide education, peer support and access to subsidised stoma appliances through the Australian Government's Stoma Appliance Scheme (SAS):
- Ostomy Australia (Victoria) — the main stoma association for Victoria, providing SAS-subsidised supplies and member support
- Australian Council of Stoma Associations (ACSA) — national peak body with a directory of Victorian associations
- Colostomy Association of Victoria — Melbourne-based group offering peer mentoring and regular meetings
- Australian Association of Stomal Therapy Nurses (AASTN) — find an accredited stomal therapy nurse near you
- Bladder Cancer Australia — disease-specific information and patient support
- Cancer Council Victoria — counselling, transport assistance and financial support (13 11 20)
Dr Dias' Approach
Dr Brendan Dias offers comprehensive robotic bladder cancer surgery for Melbourne patients, with a focus on totally intracorporeal urinary diversion, ERAS recovery and structured pre-operative stoma counselling. Where appropriate, he coordinates neoadjuvant chemotherapy with medical oncology and ensures every patient meets a stomal therapy nurse before surgery.
For more information on related procedures, see robotic radical prostatectomy and our urinary catheter at home guide.
Frequently Asked Questions
What is robotic radical cystectomy?
Robotic radical cystectomy is a keyhole operation using the da Vinci surgical system to remove the entire bladder along with surrounding lymph nodes. In men, the prostate and seminal vesicles are also removed; in women, the uterus, fallopian tubes, ovaries and a portion of the vaginal wall may be removed. After bladder removal, a new way to drain urine — a urinary diversion — is created, most commonly an ileal conduit or a neobladder.
When is radical cystectomy recommended?
Radical cystectomy is the gold-standard treatment for muscle-invasive bladder cancer (T2 and above) and for high-risk non-muscle-invasive bladder cancer that has not responded to bladder instillations such as BCG. It may also be considered for recurrent high-grade tumours that cannot be controlled by endoscopic resection.
What is the difference between an ileal conduit and a neobladder?
An ileal conduit uses a short segment of small bowel to channel urine from the ureters out through a stoma on the abdomen into an external bag. A neobladder uses a longer segment of bowel reshaped into a pouch that is joined to the urethra, so urine can be passed through the urethra in a more natural way. Neobladders avoid an external bag but require relearning bladder emptying and are not suitable for every patient.
How long is the hospital stay?
Most patients stay in hospital 5 to 8 days after robotic radical cystectomy when an enhanced recovery (ERAS) pathway is used. Neobladder patients sometimes stay slightly longer to allow safe catheter and pouch training before discharge.
How long is the recovery at home?
Most patients feel substantially better by 4 to 6 weeks and return to light activities and desk work within this time. Full recovery, including return of stamina and adaptation to the urinary diversion, typically takes 2 to 3 months. Heavy lifting is avoided for 6 weeks.
Will I need chemotherapy?
Many patients with muscle-invasive bladder cancer benefit from neoadjuvant chemotherapy (given before surgery) to improve cure rates. The need for chemotherapy is decided in a multidisciplinary team (MDT) meeting alongside medical oncology, and Dr Dias will coordinate this discussion.
Where in Melbourne does Dr Dias perform robotic cystectomy?
Dr Brendan Dias performs robotic radical cystectomy at major Melbourne hospitals with established robotic and complex pelvic surgery programs. Pre-operative counselling, stoma planning and post-operative follow-up are coordinated across his Melbourne rooms.
The Bottom Line
Robotic radical cystectomy with intracorporeal ileal conduit or neobladder offers Melbourne patients gold-standard cancer control with the recovery benefits of keyhole surgery. The right diversion is the one that fits your cancer, your kidney function and your lifestyle — a decision best made together with an experienced urologist and a stomal therapy nurse. If you or a family member has been diagnosed with bladder cancer, early specialist referral allows the full range of options to be considered.