What is cystectomy?
Cystectomy is a complex surgical procedure in which a surgeon removes some or all of the urinary bladder. The bladder stores urine before you pass it from your body.
Most often, doctors perform bladder removal surgery to treat invasive bladder cancer. Doctors sometimes perform cystectomy for benign disorders affecting the bladder and urinary system.
Your surgeon will choose one of several methods, or surgical approaches, to remove the bladder. After removing some or all of the bladder, your doctor performs reconstructive surgery. Reconstruction creates a new way to store and remove urine from your body.
What should I expect from cystectomy?
Your surgeon may remove part of your bladder (partial cystectomy) or the entire bladder (radical cystectomy).
- Partial cystectomy: Only a part of the bladder is removed. Usually, nearby lymph nodes are removed as well to determine whether any cancer has spread beyond the bladder. Lymph nodes are small bundles of tissue that filter your body’s lymph fluid and produce immune system cells. The remaining bladder is repaired and stays in the body.
- Radical cystectomy: Surgeons remove the entire bladder and nearby lymph nodes. In men, surgeons almost always cut the vas deferens and remove the prostate and seminal vesicles (parts of the male reproductive system). In women, doctors often also remove the uterus, fallopian tubes, ovaries, cervix and occasionally part of the vaginal wall.
Surgeons perform bladder removal surgery using one of two different surgical approaches:
- Open cystectomy: Your surgeon accesses your bladder and the tissues around it with one long incision in your abdomen. The surgeon’s and assistant’s hands enter the body cavity to perform the operation.
- Minimally invasive (laparoscopic or robotic) cystectomy: The abdomen is first insufflated with carbon dioxide to create working space for your surgeon. Very small incisions are made so that long instruments can be inserted into the body cavity to perform the operation. The surgeon’s and assistant’s hands do not enter the body cavity. Laparoscopic cystectomy involves the surgeon and assistant using these instruments directly. Robotic cystectomy involves attaching the instruments to a surgical robot so that the surgeon can control the instruments via a surgical console. The surgical robot enhances the operation by providing three dimensional vision and increasing instrument dexterity.
If radical cystectomy is performed, your surgeon will reconstruct the urinary tract in one of three ways so that the urine you produce can be eliminated from your body. These methods include:
- Ileal conduit: Your surgeon disconnects a short portion of your small intestine called the ileum. The ureters (tubes that carry urine from the kidney to the bladder) are attached to one end of the ileum, while the other end of the ileum is attached to an opening in the skin called a stoma. The stoma is usually located close to the belly button on the right side. A plastic appliance (ostomy bag) is placed over the stoma to collect urine.
- Continent cutaneous diversion: Your surgeon creates a reservoir to store urine from part of your small and large intestine. The ureters are attached to one end of the reservoir, and the other end of the reservoir is connected to a small opening (stoma) in the skin of your abdomen. The reservoir stores urine and must be emptied periodically by inserting a small drainage tube (catheter) into the stoma. No external bag is necessary.
- Neobladder: Your surgeon uses a long piece of small intestine to create a reservoir to store urine. The ureters are attached to one end of the reservoir, and the other end of the reservoir is connected to the urethra, the tube that carries urine out of your body. You empty your reservoir periodically by relaxing your pelvic muscles and tensing your abdominal muscles.
Risks / Benefits
What are the benefits of cystectomy?
Your doctor uses bladder removal surgery to remove cancerous tissues. The main benefit is that you have an improved chance of recovering from bladder cancer.
What are the risks of cystectomy?
Like any major surgical procedure, bladder removal surgery poses some risks, including:
- Blood clots
- Organ damage
- Reactions to anesthesia
You may also have changes in how you urinate after any bladder surgery. Your bladder is smaller after partial cystectomy, so you may need to go to the bathroom more often. If you have a radical cystectomy, your ability to urinate depends on the type of reconstructive surgery you have.
For some men, bladder removal surgery causes sexual side effects. Men may have difficulty getting and maintaining erections. Because doctors remove the seminal vesicles along with the bladder, men will no longer produce semen.
Women may also experience sexual side effects. While intercourse is still possible, it may cause discomfort if doctors remove part of the vagina. Some people have nerve damage. This damage may limit a woman’s ability to become aroused and achieve orgasm.
Recovery and Outlook
What is the prognosis (outlook) for people who have cystectomy?
Your recovery depends on the type of bladder removal surgery you have. Typically, patients who undergo a partial cystectomy will have a shorter recovery period compared with patients who undergo a radical cystectomy. Many patients will have poor appetite and abnormal bowel function (constipation, loose stools or both) immediately after radical cystectomy, and complete recovery may take several weeks to months.
When to Call the Doctor
When should I call my doctor?
After a cystectomy, contact your doctor right away if you notice any of the following symptoms:
- Signs of infection such as fever and shaking chills
- Persistent nausea and vomiting
- Heavy bleeding
- Increasing redness, swelling, pain or discharge from the surgical site
- Excessive pain that is not controlled with the medications that you were given
- Inability to urinate or difficulty with draining urine from your diversion
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