Cystectomy is a surgical procedure involving the removal of all or part of the urinary bladder. It is typically performed to address serious medical conditions affecting the bladder’s function or health. This decision is made in close consultation with medical professionals.
Reasons for Bladder Removal
Bladder removal is primarily undertaken for specific medical conditions that compromise bladder integrity or function. The most frequent reason for this surgery is bladder cancer, especially when it has invaded the muscle wall or is high-grade and aggressive. A radical cystectomy, which removes the entire bladder and often surrounding lymph nodes and organs, aims to prevent the cancer from spreading further.
Beyond cancer, severe non-cancerous bladder dysfunctions can necessitate a cystectomy. Conditions like interstitial cystitis (chronic bladder pain) or neurogenic bladder (nerve damage impairing control) may lead to intractable symptoms. These situations typically arise when other treatments have failed to provide relief or restore adequate bladder function.
Severe physical injuries to the bladder, such as those from trauma, or congenital abnormalities that render the bladder non-functional, can also lead to its removal. In these instances, the bladder may be unable to store urine safely or effectively, posing significant health risks.
Reconstructing Urinary Function
After bladder removal, the body requires a new method to store and excrete urine. Surgeons create a urinary diversion, an alternative pathway for urine to leave the body. The choice of diversion depends on various factors, including the patient’s overall health and the extent of the original condition.
One common type of urinary diversion is the ileal conduit, also known as a urostomy. A segment of the small intestine is isolated to create a channel. The ureters, which transport urine from the kidneys, are connected to this intestinal segment, and the other end forms a stoma on the abdominal wall. Urine continuously flows from the kidneys, through the conduit, into a small external pouch worn on the abdomen.
Another option is a continent cutaneous reservoir, such as an Indiana pouch. An internal pouch is constructed from a segment of the intestine to store urine inside the body. A valve prevents leakage, and a small opening (stoma) is created on the abdomen. The individual empties this internal pouch at regular intervals by inserting a catheter through the stoma.
The neobladder, or orthotopic neobladder, is a complex reconstruction that aims to mimic natural urination. A new bladder-like pouch is fashioned internally from a section of the small intestine and connected directly to the urethra. This allows urine to be stored inside the body and passed through the urethra, similar to how a natural bladder functions. Patients learn to empty the pouch by relaxing pelvic muscles and tensing abdominal muscles; some may still require catheterization for complete emptying.
Living Without a Bladder
Adjusting to life after bladder removal involves new routines for managing urinary function and adapting to physical changes. Daily management varies based on the type of urinary diversion created.
Individuals with an ileal conduit must regularly empty and change their external ostomy pouch. Maintaining proper hygiene around the stoma is crucial to prevent skin irritation and infection.
For those with a continent cutaneous reservoir, routine care involves intermittent self-catheterization through the stoma to drain the internal pouch. This requires dexterity and adherence to a strict schedule to prevent over-distension and potential complications.
Individuals with a neobladder learn to empty their new internal pouch by bearing down with their abdominal muscles, though some may also need to use a catheter, especially at night, to fully drain the neobladder.
Lifestyle adjustments are part of life without a bladder. This includes adapting clothing choices to accommodate external pouches or stomas, and modifying physical activities like exercise and travel. Most individuals can resume a full and active life with proper care.
Emotional and psychological aspects are significant during the adjustment period, as individuals may experience concerns about body image and changes in intimacy. Support groups, counseling, and open communication with healthcare providers can assist in navigating these challenges. Long-term follow-up with medical professionals is important to monitor kidney function, detect complications such as urinary tract infections or stone formation, and ensure the urinary diversion functions effectively.