Cystectomy

Cystectomy is a surgical procedure to remove the bladder, either partially or entirely, depending on the condition being treated. It is primarily used to manage bladder cancer but may also be performed for other serious conditions affecting the bladder.

Types of Cystectomy

1. Partial Cystectomy:

   • Purpose: Removes only a part of the bladder, typically where the tumor is located, while preserving the remaining bladder tissue.
   • Indications: Used for localized bladder cancer when the cancer is confined to a specific area and the rest of the bladder is healthy.

2. Radical Cystectomy:

   • Purpose: Removes the entire bladder along with surrounding tissues such as the prostate and seminal vesicles in men, or the uterus, ovaries, and part of the vaginal wall in women.
   • Indications: Typically performed for invasive bladder cancer or severe bladder disease.

Surgical Approaches

1. Open Cystectomy:

   • Description: Involves a large incision in the abdomen to access and remove the bladder.
   • Indications: Used for complex cases or when extensive surgery is required.

2. Laparoscopic Cystectomy:

   • Description: Performed through several small incisions using a camera and specialized instruments.
   • Indications: Preferred for its minimally invasive nature, leading to potentially quicker recovery and less postoperative pain.

3. Robotic-Assisted Laparoscopic Cystectomy:

   • Description: A type of laparoscopic surgery where the surgeon uses a robotic system for enhanced precision and control.
   • Indications: Used for complex cases or when greater accuracy is needed.

Procedure Overview

1. Preparation:

   • Anesthesia: General anesthesia is administered.
   • Positioning: The patient is positioned to provide optimal access to the bladder.

2. Incision and Access:

   • Open Surgery: A large incision is made in the abdomen.
   • Laparoscopic/Robotic Surgery: Several small incisions are made, and instruments are inserted.

3. Bladder Removal:

   • Partial Cystectomy: The affected portion of the bladder is removed.
   • Radical Cystectomy: The entire bladder and sometimes other nearby organs or tissues are removed.

4. Urinary Diversion:

   • After bladder removal, a new method for urine storage and excretion is created. This can be:
     • Ileal Conduit: A segment of the intestine is used to create a stoma (an opening) on the abdomen through which urine is collected in an external bag.
     • Orthotopic Neobladder: A new bladder is created from a segment of the intestine and placed in the usual bladder location, allowing for a more natural urination process.
     • Continent Urinary Reservoir: An internal pouch is created from intestinal segments, and urine is drained through a catheter inserted into the abdomen.

5. Closure:

   • Open Surgery: The incision is closed with sutures or staples.
   • Laparoscopic/Robotic Surgery: Small incisions are closed, often with absorbable sutures or glue.

Recovery and Aftercare

• Hospital Stay: Typically 5-10 days, depending on the type of cystectomy and the patient’s recovery.
• Pain Management: Pain is managed with medications, and some discomfort is normal.
• Activity: Gradual return to normal activities is advised, with restrictions on heavy lifting and strenuous activities for several weeks.
• Urinary Management: Depending on the type of urinary diversion, patients will need to adapt to new methods of urine collection or management.
• Follow-Up: Regular follow-up appointments are necessary to monitor recovery, manage any complications, and assess bladder function and urinary diversion.

Potential Risks and Complications

• Infection: Risk of wound or urinary tract infections.
• Bleeding: Possible internal bleeding or hematoma.
• Urinary Issues: Complications related to the urinary diversion, such as leakage or blockage.
• Sexual Function: Potential impact on sexual function and fertility, especially with radical cystectomy.
• Complications Related to Anesthesia: As with any surgery, risks associated with anesthesia and surgical procedures.

Benefits

• Effective for Cancer Treatment: Often necessary for managing invasive bladder cancer and other serious bladder conditions.
• Minimally Invasive Options: Laparoscopic and robotic-assisted techniques offer benefits like less pain and faster recovery compared to open surgery.

Discussing the procedure with your urologist or surgeon will help you understand the specifics of your surgery, the expected recovery, and the adjustments you may need to make for urinary diversion. This will help ensure that you are well-prepared and informed about your treatment plan