A Case for Confidence after Cystoprostatectomy

At 80, Dick had undergone multiple procedures and treatments to manage his bladder cancer, severe urinary frequency, urgency, and BPH symptoms. After BCG treatments failed to work due to his specific cancer, the procedure that finally brought relief and a cure was a radical cystoprostatectomy with bilateral pelvic lymphadenectomy and ileal conduit urinary diversion—removal of the bladder, prostate, pelvic lymph nodes (to test for spread), and creation of a stoma and ostomy bag to act as a new urinary pathway. 

A few years before surgery, Dick was referred to Nebraska Urology and Dr. Wiltfong by both his primary care doctor and a close friend with similar symptoms. He and his wife worked closely with Dr. Wiltfong to manage symptoms and find cancer treatment options. 

“I always appreciated how transparent and open Dr. Wiltfong was to any suggestions that my wife and I had.” 

They explored various treatments, some of which brought temporary relief. 

The couple loved taking road trips, but Dick’s worsening condition limited travel, as he needed a restroom every 20 minutes. Dr. Wiltfong offered temporary solutions but knew a more lasting approach was needed to restore their lifestyle. 

Dr. Brush was brought in to explore options. During a visit, both doctors asked Dick about his goals for treatment. He responded, “I want to see what you both come up with, we can choose a game plan after.” 

Dr. Brush recommended a radical cystoprostatectomy with lymphadenectomy and ileal conduit diversion. After discussing it, the couple decided to move forward. 

“I loved the idea Dr. Brush presented,” Dick said. “I hoped it would make me a better person to be around—that I wouldn’t need to excuse myself every few minutes.” 

Urinary urgency 

Urinary frequency 

Urinary incontinence 

BPH (Benign Prostatic Hyperplasia or enlarged prostate) 

Dick underwent a robotic-assisted radical cystoprostatectomy, a surgery to remove the bladder, prostate, and nearby lymph nodes using small incisions and robotic tools. 

Since the bladder was removed, a small piece of intestine was used to create a new urinary pathway, called an ileal conduit. This connects the kidneys to a stoma, allowing urine to drain into a small bag worn outside the body. 

Dick experienced immediate relief. “I was able to sleep through the night right away,” he shared. When it came to his stoma and bag, he said, “I don’t even know I have it on.” 

This outcome reduced his anxiety, helped him feel more in control, and most importantly cancer-free. He continues to follow up with Dr. Brush to ensure long-term comfort and success. 

This case shows that radical cystoprostatectomy with ileal conduit diversion can be highly effective for patients with chemo-resistant bladder cancer. 

Dick’s outcome demonstrates how this approach can not only treat cancer but restore quality of life. 

“Dr. Brush is like a friend talking to you—so personable,” says Dick. “He was clear and to the point; he never lectured us. We were included.” 

His wife adds, “Dr. Brush gave me my husband back.”