It is a surgery to remove all or part of the bladder.
Cystectomy in the 21st century is a safe and effective procedure with many ways to treat the urinary system after bladder removal.
Most patients choose to create a new bladder using a bowel once the bladder is removed, but there are other ways to drain urine.
A bag in the skin or a new bladder is attached to the catheterized skin to release urine.
Types of cystectomy
The procedure to remove the entire bladder is known as a “radical cystectomy.”
It is known as a radical because it involves removing the entire bladder and any other adjacent structures where the bladder cancer has spread.
Although this seems very extreme, this prevention is of the utmost importance in bladder cancer, which can be fatal if not adequately controlled at the initial diagnosis.
A partial cystectomy removes part of the bladder.
In a partial cystectomy, your doctor will only remove part of the bladder.
Nerve-sparing cystectomy or partial cystectomy is a surgical procedure of choice for more doctors.
It is most often done to treat bladder cancer. If the tumor is early, this surgery can help cure it.
After surgery, the bladder will still be able to work. The reasons for a cystectomy include:
- Cancer of the bladder.
- Problems with muscle nerve control in the bladder.
- Damage to the bladder from radiation or chemotherapy.
- Bladder damage or bleeding caused by other conditions, treatments, or injuries.
Before a cystectomy, the patient should quit smoking, and the doctor should be told about the medications they are taking.
You may need to take antibiotics to prevent infection and laxatives from cleaning the intestines.
You may be asked to stop taking some medications up to a week before the procedure.
The patient must be fasting and not eat or drink anything after the time indicated by the doctor or on the morning of the procedure. This includes avoiding clear liquids, coffee, tea, and water.
General anesthesia is used in this procedure. The doctor makes an incision in the abdomen to expose the bladder.
The cancerous bladder is removed through this small incision in the lower abdomen below the navel.
In a radical cystectomy, all the blood vessels in the bladder are cut. The doctor removes the bladder and nearby organs that may contain cancer cells.
The doctor then creates a new way to remove urine from the body.
There are procedures to build a new bladder, called the neobladder or substitute bladder, created with the patient’s tissues and made through the same incision.
A bag outside the abdomen can also be catheterized.
Partial cystectomy will involve removing a part of the bladder and closing it so that while the bladder’s capacity is smaller, it will still function.
Surgical advances such as laparoscopic and robotic surgery allow the urologic surgeon to gently penetrate the nerve bundles without damaging them, increasing the chances of maintaining sexual function such as the nerve bundles responsible for erection.
Suppose the cystectomy is performed when the patient has cancer. This will include the removal of nearby lymph nodes and other organs in the bladder area that are also at risk for cancer.
In women, the bladder can be removed along with the urethra, ovaries, fallopian tubes, uterus, and part of the anterior vaginal wall.
In women who are not menopausal, the ovaries and fallopian tubes can be preserved during this operation.
In men, the prostate is removed, with part of the vas deferens, urethra, lymph nodes, and seminal vesicles; it can also be removed with the bladder.
These radical cystectomy procedures also have different names.
Female radical cystectomy is often referred to as an ovarian cystectomy or anterior pelvic exenteration, while a male radical cystectomy is a cystoprostatectomy.
Advantages of Robotic Cystectomy
The normal cystectomy lasts about 3-6 hours; the recovery is painful and requires a hospital stay of 5 to 12 days.
There is less blood loss and need for transfusions with robotic cystectomy than with radical cystectomy. Less need for pain medications, better manipulation, and nerve bundles essential for sexual function can be preserved.
In addition, the surgical incision is smaller than in conventional surgery.
Care after the procedure
You may need to stay in the intensive care unit in the hospital. A tube is usually connected that runs from your nose to your stomach, and you will receive fluids through an IV.
If a urine bag were attached during surgery, the patient would be taught how to dispose of urine.
When the patient returns home, you should help ensure a smooth recovery by following these guidelines:
- You should avoid strenuous physical activity for 4 to 6 weeks.
- Avoid lifting heavy objects, straining, or engaging in sexual activity until instructed to do so by your doctor.
- Likewise, the doctor will indicate when it is safe to climb the stairs, shower, bathe or submerge in water.
Complications of Cystectomy
The doctor will advise the patient of the list of possible complications. These may include:
- Loss of sexual function.
- Accumulation of fluid in the abdominal cavity.
- Damage to other organs.
- Blockage of urine flow from the ureters to the bladder.
- Nutrition problems depend on the intestinal segments used to create a way to drain urine.
- Blood clots in the legs.
- Reaction to anesthesia.
- Urinary incontinence
- Pneumonia or other lung problems.
- Healing problems.
- Urine leakage at the incision site of the bladder.
- Damage to nearby nerves, tissues, or organs.
- The bladder cannot hold as much urine as it used to.
- Not all the cancerous tissue can be removed, or cancer can come back.
- Risks of anesthesia.
- Previous surgery to the abdomen or pelvis or radiation to the area increases the risk of complications.