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Cystectomy

Cystectomy is a surgical procedure primarily used to treat bladder conditions, including bladder cancer. Cystectomy refers to the surgical removal of all or part of the bladder. There are two main types: radical cystectomy, where the entire bladder is removed, and partial cystectomy, where only a portion of the bladder is excised.

The procedure is commonly employed to treat conditions such as bladder cancer.

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Why is Cystectomy Performed?

Cystectomy is a surgical intervention primarily indicated for the treatment of bladder cancer. Bladder cancer is characterised by the abnormal growth of cells in the bladder, which can form tumours and, if left untreated, spread to other parts of the body. The primary goal of cystectomy is to remove these malignant tumours and prevent the progression and metastasis of the disease.

Preparing for Cystectomy

Before the procedure, patients undergo various pre-operative tests to assess their suitability for surgery. These evaluations ensure the patient’s safety during the operation. On the day of the surgery, patients might receive specific dietary guidelines and instructions regarding their medications.

The Cystectomy Procedure

Cystectomy is a surgical procedure that involves the removal of the bladder. The specific approach and steps taken during the surgery can vary based on the type of cystectomy being performed and the individual patient’s needs. Here’s a detailed elaboration:

Preparation

  • Before the surgery begins, the patient is prepared in the operating room. This includes cleaning the surgical area and positioning the patient appropriately.
  • General anaesthesia is administered to ensure the patient is unconscious and free from pain throughout the procedure.

Incision

  • The surgeon makes an incision in the lower abdomen to access the bladder. The size and type of incision can vary based on the surgical approach (open surgery vs. minimally invasive techniques).

Removal of the Bladder

  • For a partial cystectomy, only the portion of the bladder containing the tumour is removed. The rest of the bladder is left intact.
  • In a radical cystectomy, the entire bladder is removed. For men, this might also include the removal of the prostate and seminal vesicles. For women, the uterus, fallopian tubes, ovaries, and part of the vagina might be removed.

Urinary Diversion

After the bladder is removed, a new way for the body to store and eliminate urine is created. There are several methods for urinary diversion:

  • Ileal Conduit: A small piece of the intestine is used to create a conduit between the ureters and the outside of the body. Urine flows into an external ostomy bag.
  • Neobladder: A section of the intestine is reshaped to form a new bladder, allowing patients to urinate in a more natural manner.
  • Continent Urinary Reservoir: A pouch is created from a section of the intestine, and urine is drained by inserting a catheter through a stoma.

Closure

  • Once the procedure is complete, the incision is closed using sutures or surgical staples. Drains might be placed to remove any accumulating fluids.

Recovery

The patient is taken to a recovery room where vital signs are closely monitored. Once stable, the patient is moved to a hospital room for further recovery.

Post-operative Care

  • Pain management is a priority after the surgery. Medications are provided to alleviate discomfort.
  • The medical team will provide guidance on caring for the surgical site, managing the urinary diversion (if applicable), and recognising signs of complications.

 

The duration of the cystectomy procedure can vary based on the complexity of the case and the type of urinary diversion chosen. Patients should follow post-operative instructions closely and attend all follow-up appointments to ensure a smooth recovery and optimal outcomes.

Recovery After Cystectomy

Following the surgery, patients are closely monitored to manage any immediate postoperative complications. The hospital stay’s length depends on the patient’s health and the surgery’s specifics. After discharge, patients may need to make certain lifestyle adjustments and follow specific care guidelines to ensure a smooth recovery.

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Conclusion

Cystectomy plays a pivotal role in treating bladder conditions, especially bladder cancer. Individuals should consult with healthcare professionals to understand the procedure fully and make informed decisions about their health.

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Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK

Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    What is the difference between radical and partial cystectomy?
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    Radical cystectomy involves the removal of the entire bladder, while partial cystectomy removes only a section of it.

    How long is the recovery period after cystectomy?
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    Recovery varies among patients, but most can resume normal activities within six to eight weeks.

    What are the potential complications of cystectomy?
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    As with any surgery, cystectomy carries risks, including infections, bleeding, and anaesthesia-related complications.

    How will a cystectomy affect my daily life?
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    Post-surgery, patients may need to use alternative methods for urine storage and excretion, which can require lifestyle adjustments.

    Are there any dietary restrictions after the procedure?
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    Dietary guidelines post-surgery depend on individual cases, but most patients are advised to maintain a balanced diet.

    What are the signs of complications I should watch out for post-surgery?
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    Persistent pain, unusual swelling, and signs of infection are potential indicators of post-operative complications.