A cystectomy is a surgical procedure for the removal of the urinary bladder. In some cases, surrounding tissues and organs in the pelvis are also removed, depending on the underlying health condition being treated.
This surgery is most commonly performed to treat bladder cancer but may also be indicated for other severe bladder conditions, such as significant bladder dysfunction.
Types of Cystectomy
Cystectomy procedures vary mainly by the extent of bladder removal and the surgical method used. Here are the main types of cystectomy:
Partial Cystectomy
In a partial cystectomy, only a portion of the bladder is removed. This procedure is suitable for patients whose cancer is located in one area of the bladder and has not spread to the muscle layer.
Radical Cystectomy
Radical cystectomy involves the removal of the entire bladder along with nearby lymph nodes, part of the urethra, and, depending on the patient’s sex, potentially the prostate and seminal vesicles in men, or the uterus, ovaries, and part of the vagina in women.
Robotic Cystectomy
Robotic cystectomy is a minimally invasive approach to radical cystectomy, performed using robotic surgical systems. This method offers the surgeon enhanced precision, flexibility, and control.
Reasons for Cystectomy
Here are the common reasons for undergoing a cystectomy:
Bladder Cancer: Bladder cancer is the most common indication for a cystectomy.
Cystectomy may also be considered for certain severe non-cancerous conditions when other treatments have failed, including:
Interstitial cystitis: A chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain.
Neurogenic bladder: Dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of urination.
Bladder trauma: Severe injuries to the bladder that cannot be repaired by other surgical means.
The Cystectomy Procedure
The cystectomy procedure involves several steps, such as:
Preoperative Preparation
Patients undergoing cystectomy typically undergo a thorough preoperative assessment, including blood tests, imaging studies, and sometimes cardiac and pulmonary evaluations, to ensure they are fit for surgery.
Surgical Procedure
- Anaesthesia: Cystectomy is performed under general anaesthesia.
- Incision: For a traditional open cystectomy, a single large incision is made across the abdomen to access the bladder. For robotic and laparoscopic cystectomies, several small incisions are made to accommodate surgical instruments and a camera.
- Removal of the Bladder: The bladder, and often surrounding lymph nodes and other tissues, are removed. The extent of tissue removal depends on the underlying condition and the type of cystectomy.
- Urinary Diversion: After removing the bladder, surgeons must create a new way for urine to exit the body. Options include:
- Ileal conduit urinary diversion: Using a piece of the intestine to create a conduit outside the abdomen.
- Continent urinary reservoir: Creating a reservoir that can be emptied by inserting a catheter through the abdomen.
Postoperative Care
Postoperative care involves monitoring for signs of infection, managing pain, and ensuring proper surgical site healing. Patients may need to stay in the hospital for several days to a few weeks, depending on the surgery’s complexity and overall health.
Potential Risks and Complications
Cystectomy, like any major surgery, carries potential risks and complications, including:
Immediate Postoperative Risks
Bleeding: Significant blood loss can occur during or after the surgery, sometimes necessitating blood transfusions.
Infection: Surgical sites, urinary diversions, or the bloodstream can become infected.
Anaesthetic Complications: Reactions to anaesthesia can affect cardiac and respiratory functions.
Long-term Complications
Urinary Tract Infections (UTIs): Patients with any form of urinary diversion are at increased risk of UTIs.
Bowel Obstruction: Scar tissue from surgery can cause obstructions in the intestines.
Ureteral Stricture: Narrowing of the ureters, which can lead to kidney problems.
Surgical Failure or Recurrence of Disease
Cancer Recurrence: There is always a risk that cancer can recur, even after the removal of the bladder and surrounding tissues.
Complications from Urinary Diversion: Complications arising from urinary diversions, such as issues with the constructed urinary pathways, may require additional surgeries.
Conclusion
Cystectomy is a surgical procedure to manage and treat bladder cancer or other severe bladder conditions. The decision to undergo a cystectomy involves careful consideration of the benefits and risks associated with the procedure. Choosing the right surgical option and understanding the potential outcomes are important for managing one’s health effectively.
For more detailed information about cystectomy, or to discuss whether this surgical option might be appropriate for your condition, consider scheduling a consultation with our clinic. Our team is ready to provide you with comprehensive advice and support tailored to your health needs.
