A cystectomy involves the surgical removal of the urinary bladder. This procedure is performed when the bladder is affected by severe diseases or conditions that cannot be managed through less invasive treatments. The decision to undergo a cystectomy is made after considering a patient’s condition and treatment options.
Understanding Cystectomy Types
A cystectomy can be performed in two main ways, depending on the extent of the disease. A partial cystectomy involves removing only a segment of the bladder. This approach is considered when a tumor or diseased area is localized and does not affect the entire bladder wall. The remaining bladder tissue is then reconnected to allow for continued urine storage.
In contrast, a radical cystectomy involves the removal of the entire bladder. For men, this procedure includes the removal of the prostate and seminal vesicles. For women, it involves the removal of the uterus, ovaries, fallopian tubes, and a portion of the vagina, along with the bladder. This more extensive surgery is necessary when the disease has spread throughout the bladder or is particularly aggressive.
Reasons for a Cystectomy
The primary reason for performing a cystectomy is bladder cancer. This surgery is often recommended for muscle-invasive bladder cancer, where cancerous cells have grown into the deeper layers of the bladder wall. High-grade, non-muscle-invasive bladder cancer that has not responded to other treatments, such as immunotherapy or chemotherapy, may also require a cystectomy. The extent of the cancer and its potential to spread are important factors in determining the need for this procedure.
Beyond cancer, a cystectomy may be considered for other severe, non-cancerous conditions affecting the bladder. These can include intractable interstitial cystitis, which causes chronic pain and pressure in the bladder area, or severe chronic radiation cystitis, a condition resulting from radiation therapy that leads to significant bladder dysfunction and bleeding. These conditions, when unresponsive to other therapies, can severely impact a person’s quality of life, making bladder removal a necessary option.
The Surgical Procedure
A cystectomy involves the removal of the bladder, either partially or entirely. After bladder removal, the surgeon creates a new way for urine to exit the body, a process known as urinary diversion.
One common method is an ileal conduit. A small segment of the small intestine creates a channel. One end connects to the ureters, which carry urine from the kidneys. The other end forms a stoma on the abdominal wall, where urine collects in an external pouch.
Another option is a neobladder, which involves creating a new internal bladder from a section of the patient’s small intestine. This newly constructed bladder is then connected to the ureters and the urethra, allowing for more natural urination, though it requires learning new techniques to empty the bladder. A continent cutaneous diversion offers a third approach, where an internal pouch is created from a segment of the intestine, and a small opening (stoma) is made on the abdominal wall. Urine collects in this pouch and is periodically drained by inserting a catheter through the stoma.
Cystectomies can be performed using traditional open surgery, which involves a single, larger incision in the abdomen. Alternatively, they can be done using minimally invasive techniques, such as laparoscopic or robotic-assisted surgery. These minimally invasive approaches involve several small incisions through which specialized instruments and a camera are inserted. Robotic assistance provides surgeons with enhanced precision and visualization, which can lead to less blood loss and a shorter hospital stay.
Post-Operative Recovery and Adaptations
Following a cystectomy, patients remain in the hospital for five to seven days. During this initial recovery period, pain management is a priority. Close monitoring for complications such as infection, bleeding, or issues with bowel function is also done. Patients gradually begin to move around and consume liquids, progressing to solid foods as their digestive system recovers. Learning to manage the new urinary diversion system begins in the hospital with healthcare professionals.
Life after a cystectomy involves significant adjustments, particularly for those with an ileal conduit or continent cutaneous diversion who will manage a stoma. Patients learn how to care for the stoma, change external pouches, and maintain skin integrity around the opening. For individuals with a neobladder, adapting to the new way of urinating involves scheduled voiding and sometimes using abdominal pressure to empty the reconstructed bladder. Follow-up appointments monitor kidney function, check for any complications, and ensure the patient is adjusting well to their new anatomy. These long-term adaptations are important for maintaining quality of life and overall health.