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.