Cystectomy for Bladder Cancer

Overview

Bladder cancer is a serious condition that may require surgical intervention to remove the cancerous tissue. One of the primary surgical treatments for bladder cancer is a cystectomy. This procedure involves the removal of the bladder and is often recommended when the cancer is invasive or high-grade. In this blog, we will explore what a cystectomy is, the reasons it is performed, the different types of cystectomy, the procedure itself, and what to expect during recovery.

What is a Cystectomy?

A cystectomy is a surgical procedure to remove all or part of the bladder. It is primarily performed to treat bladder cancer but may also be necessary for other conditions such as severe bladder dysfunction or congenital abnormalities. There are two main types of cystectomy:

1. Partial Cystectomy: Only a portion of the bladder containing the cancerous tissue is removed. This is typically performed when the cancer is localized to one area and has not spread extensively.
2. Radical Cystectomy: The entire bladder is removed along with surrounding lymph nodes and, in men, the prostate and seminal vesicles, and in women, the uterus, ovaries, and part of the vagina. This is usually done when the cancer is invasive or high-grade.

Why is a Cystectomy Performed?

Cystectomy is performed for several reasons, including:

1. Bladder Cancer: To remove cancerous tissue that has invaded the bladder muscle or is high-grade and at risk of spreading.
2. Recurrent or High-Risk Cancer: When cancer recurs despite other treatments or is deemed high-risk for progression.
3. Non-Cancerous Conditions: In rare cases, severe bladder dysfunction, interstitial cystitis, or congenital abnormalities may require bladder removal.

The Cystectomy Procedure

1. Preparation:
   • Before the procedure, a thorough evaluation is conducted, including imaging tests (CT scans, MRIs), blood tests, and a physical examination. The patient will discuss the procedure, risks, and benefits with their healthcare provider.
   • Patients are typically advised to stop certain medications, fast for several hours before surgery, and may be given bowel prep instructions.
2. Anesthesia:
   • Cystectomy is performed under general anesthesia, ensuring the patient is unconscious and pain-free during the procedure.
3. Surgical Procedure:
   • Open Cystectomy: An incision is made in the lower abdomen to access and remove the bladder. This traditional method allows the surgeon to have a direct view and access to the bladder and surrounding structures.
   • Laparoscopic (Minimally Invasive) Cystectomy: Several small incisions are made, and specialized instruments, including a camera, are used to perform the surgery. This method typically results in less postoperative pain and quicker recovery.
   • Robot-Assisted Laparoscopic Cystectomy: Similar to laparoscopic cystectomy, but the surgeon uses a robotic system to enhance precision and control.
4. Urinary Diversion:
   • After bladder removal, a new way to store and expel urine must be created. There are three main types of urinary diversion:
     • Ileal Conduit: A small segment of the intestine is used to create a conduit for urine to pass from the ureters to an external stoma (opening) on the abdominal wall, where it drains into a collection bag.
     • Continent Urinary Reservoir: A pouch is created from a segment of the intestine, allowing urine to be stored internally and emptied through a catheter inserted into a stoma.
     • Orthotopic Neobladder: A new bladder is constructed from a segment of the intestine and connected to the urethra, allowing for more natural urination.

Recovery and Aftercare

Recovery from a cystectomy involves several important steps:

1. Hospital Stay:
   • Most patients stay in the hospital for about 5 to 10 days after surgery. During this time, medical staff monitor recovery, manage pain, and ensure the new urinary diversion is functioning correctly.
2. Activity Restrictions:
   • Patients are generally advised to avoid heavy lifting, strenuous activities, and driving for several weeks. Gentle activities like walking are encouraged to promote circulation and prevent blood clots.
3. Wound Care:
   • Proper care of the surgical site and any stomas is crucial to prevent infection. Patients will receive instructions on how to clean and manage their wounds.
4. Diet and Hydration:
   • A balanced diet and adequate hydration are essential for healing. Patients may need to adjust their diet initially, following their healthcare provider’s recommendations.
5. Follow-Up Appointments:
   • Regular follow-up appointments are necessary to monitor recovery, manage any complications, and ensure the urinary diversion is functioning properly.

Benefits of Cystectomy

Cystectomy offers several key benefits:

• Cancer Control: Removes the primary source of invasive or high-grade bladder cancer, reducing the risk of spread and recurrence.
• Symptom Relief: Alleviates symptoms associated with advanced bladder cancer, such as pain, bleeding, and urinary obstruction.
• Improved Quality of Life: For patients with severe bladder dysfunction or recurrent cancer, cystectomy can significantly improve quality of life.

Risks and Complications

While cystectomy is generally safe, it does carry some risks, including:

• Infection
• Bleeding
• Blood clots
• Injury to surrounding organs
• Urinary leakage or incontinence
• Bowel obstruction
• Sexual dysfunction