Bladder removal surgery, medically known as a cystectomy, involves removing part or all of the urinary bladder. This surgery primarily treats aggressive bladder cancer, especially when it has grown into muscle tissue or hasn’t responded to other treatments. It may also be considered for severe non-cancerous conditions like chronic inflammation or birth defects, when other therapies fail. Patients and their families often have concerns about this major surgery and its implications.
Understanding Bladder Removal Surgery
Cystectomy has two main types: partial and radical. A partial cystectomy removes only a section of the bladder, typically when a tumor is confined and has not spread. This less common approach allows the remaining bladder to continue functioning.
A radical cystectomy involves removing the entire bladder. This procedure is performed for muscle-invasive bladder cancer or when the cancer is high-risk and persistent. During a radical cystectomy, surrounding lymph nodes are also removed to check for cancer spread.
For men, a radical cystectomy often includes removing the prostate and seminal vesicles. For women, it may involve removing the uterus, ovaries, fallopian tubes, and sometimes part of the vagina. After a radical cystectomy, a urinary diversion must be created for urine to exit the body.
Potential Risks and Complications
Bladder removal surgery carries general surgical risks. These include adverse reactions to anesthesia, bleeding, and infection at the surgical site or throughout the body.
Blood clots, such as deep vein thrombosis or pulmonary embolism, can also occur. Injury to surrounding organs, like the bowel or nerves, is also possible during the surgical removal.
Specific complications arise directly from bladder removal and urinary diversion. When a segment of the bowel is used for diversion, issues like bowel obstruction or changes in bowel function can occur. Anastomotic leaks, where reconnected sections of the bowel or urinary tract leak, are also a potential complication.
Urinary diversion methods, such as an ileal conduit, neobladder, or continent cutaneous reservoir, each have their own complications. For ileal conduits, problems may include stoma complications like narrowing or retraction, and stone formation. Neobladders may lead to issues with continence, such as daytime or nighttime leakage, or difficulty emptying the new bladder, sometimes requiring catheterization.
Metabolic imbalances, such as acidosis, can develop due to the absorption properties of the bowel segment used for diversion. Ureteral complications, specifically ureteral stricture where the tubes connecting the kidneys to the diversion narrow, can impair kidney function. Fistula formation, an abnormal connection between organs, is another possible complication.
Sexual dysfunction is a common consequence for both men and women after radical cystectomy. Men may experience erectile dysfunction due to nerve damage, affecting up to 80% of men. Women may face changes in sensation or altered vaginal anatomy, impacting sexual function.
A lymphocele, a collection of lymph fluid where lymph nodes were removed, can occur. The overall complication rate for urinary diversion can be as high as 60% in long-term follow-up, with stoma-related complications and urinary tract infections being common.
The Recovery Journey
Recovery after bladder removal surgery spans several weeks to months. Patients typically remain in the hospital for about a week. During this initial period, pain management is a focus, and drains may be present to remove fluid.
Early mobilization, like short walks, is encouraged to aid recovery and prevent complications. At home, patients often experience fatigue. Managing the urinary diversion, whether a stoma or neobladder, becomes a new daily routine requiring adaptation.
Dietary adjustments may be necessary as the bowel recovers. While many can resume light activities or return to work within 4 to 6 weeks, full recovery often takes 6 to 12 weeks or more.
Factors Affecting Surgical Safety and Outcomes
Surgical safety and outcomes are influenced by patient characteristics and procedural factors. A patient’s overall health before surgery plays a role. Pre-existing conditions like heart disease, diabetes, or obesity can increase surgical risks and affect recovery.
The experience of the surgical team and the hospital’s procedure volume are important. Hospitals and surgeons who frequently perform cystectomies tend to have lower complication rates, contributing to better patient outcomes.
The specific surgery type, whether partial or radical cystectomy, and the chosen urinary diversion method, also impact the risk profile. Radical cystectomy is generally more complex than partial cystectomy, and each diversion method carries unique risks.
Thorough pre-operative preparation by the patient can help mitigate risks. This includes stopping smoking, optimizing chronic medical conditions, and adhering to dietary guidelines. Such preparation helps ensure the patient is in the best possible condition for surgery.