Bladder Cystectomy

Bladder cystectomy is the full or partial surgical removal of the bladder to treat invasive bladder cancer.

Some facts about Bladder Cystectomy:

• Some or all of the urinary bladder that stores urine before you pass it from your body will be removed during Cystectomy.
• Most often, Cystectomy is performed by the doctors to treat invasive bladder cancer.
• Cystectomy can also be done for benign disorders affecting the bladder and urinary system.
• One of several methods, or surgical approaches, will be choosen by the surgeon to remove the bladder.
• Reconstructive surgery will be performed after removing some or all of the bladder tocreate a new way to store and remove urine from your body.
• Removing the entire bladder typically includes removal of the prostate and seminal vesicles in men which is called as radical cystectomy.
• Radical cystectomy also involves removal of the uterus, ovaries and part of the vagina in case of women.
• Other pelvic tumors such as advanced colon, prostate or endometrial cancer and some benign or noncancerous conditions such as interstitial cystitis or congenital abnormalities can be treated by cystectomy.
• Cystectomy is recommended for the treatment of cancer that begins in the bladder or that begins nearby and grows to involve the bladder.
• Cystectomy is also recommended for the treatment of birth defects that affect the urinary system and neurological or inflammatory disorders that affect the urinary system.
• Bleeding, Blood clots, Heart attack, Infection and Pneumonia are some of the possible risk of cystectomy. Death can also happen after surgery which is very rare
• Dehydration, Electrolyte abnormalities, Urinary tract infection, bowel obstruction and ureter blockage are some of the additional risks associated with cystectomy as the surgery not only just remove the bladder but also create a urinary diversion

Types of Bladder Cystectomy:

The type of cystectomy and reconstruction to be perormed depends on several factors, such as the reason for your surgery, your overall health and your preferences. Partial cystectomy and Radical cystectomy are two types of Bladder Cystectomy.

Partial cystectomy:

Partial cystectomy involves the removal of a part of the bladder. Lymph nodes are small bundles of tissue that filter the lymph fluid o your body and produce immune system cells. The nearby lymph nodes are also removed during partial cystectomy to determine whether any cancer has spread beyond the bladder. The remaining bladder will be repaired and stays in the body.

Radical cystectomy:

Radical cystectomy involves the removal of entire bladder and nearby lymph nodes. The vas deferens will be cut and the prostate and seminal vesicles will be removed in men where as the uterus, fallopian tubes, ovaries, cervix and occasionally part of the vaginal wall will be removed in women.

Preparation for Bladder Cystectomy:

• You must inform  about the medicines you are taking and your use of caffeine, alcohol or other drugs to your doctor before surgery as you may need to make changes to your medications or avoid certain substances to help with healing and recovery after surgery.
• You need to quit smoking before surgery if you are smoking as it increases the risk of developing problems after surgery.
• You will receive specific instructions on how to prepare for the procedure when you schedule your surgery.

Procedure for Bladder Cystectomy:

• You will be given general anesthesia that keeps you asleep during surgery.
• Your abdomen will be cut by the surgeon once you are asleep. One larger incision will be made for open surgery or several smaller incisions for minimally invasive or robotic surgery.
• Your bladder will be removed along with nearby lymph nodes.
• Other organs near the bladder such as the urethra, prostate and seminal vesicles in men and the urethra, uterus, ovaries and part of the vagina in women may also be removed.
• The urinary tract will be reconstructed in order to allow urine to leave your body.
• Your bladder and the tissues around it will be accessed by the surgeon with one long incision in your abdomen during Open cystectomy. The operation will be performed by entering the hands of surgeon and assistant in to the body cavity.
• Several small incisions will be made on your abdomen by the surgeon where special surgical tools are inserted to access the abdominal cavity during minimally invasive surgery. The hands of surgeon and assistant will not enter in to the body cavity as long instruments can be inserted into the body cavity to perform the operation. These instruments are used directly in Laparoscopic cystectomy.
• The instruments are attached to a surgical robot so that the surgeon can control the instruments through a surgical console in Robotic cystectomy. The operational procedure can be enhanced by providing three dimensional vision and increasing instrument dexterity.

Methods to reconstruct the urinary tract:

Ileal conduit, Continent cutaneous diversion and Neobladder are three methods using which the urinary tract is reconstructed. One of three ways can be used to reconstruct the urinary tract so that the urine you produce can be eliminated from your body.

Ileal conduit:

A short portion of your small intestine called the ileum will be disconnected and the ureters will be attached to one end of the ileum. The other end of the ileum is attached to an opening in the skin called a stoma which is usually located close to the belly button on the right side. A ostomy bag is placed over the stoma to collect urine.

Continent cutaneous diversion:

A reservoir will be created by the surgeon to store urine from part of your small and large intestine. The ureters are connected to one end of the reservoir and the other end of the reservoir is connected to the stoma in the skin of your abdomen. No external bag is necessary in this case as the reservoir will be emptied periodically by inserting catheter into the stoma.

Neobladder:

A long piece of small intestine will be used by the surgeon to create a reservoir to store urine. The ureters are connected to one end of the reservoir, and the other end of the reservoir is attached to the urethra. Your reservoir will be emptied periodically by relaxing your pelvic muscles and tensing your abdominal muscles.