Cystectomy

What is a cystectomy?

A cystectomy is a surgical procedure in which the bladder is removed for a variety of reasons. These indications most commonly are due to invasive bladder cancer, but can also include benign conditions. There are several types of cystectomy that may be performed:

  • Radical cystectomy: This is a surgical procedure in which the bladder and surrounding fatty tissues are removed with a wide margin. Adjacent pelvic organs are also removed. This includes the prostate in a man and the uterus and part of the vaginal wall in a woman. This surgery is primarily performed for invasive or advanced bladder cancer.
  • Partial cystectomy: This is a surgical procedure in which part of the bladder wall is removed and the remaining bladder is preserved. There are limited indications for this type of procedure, as it does not provide as effective cancer control as a radical cystectomy. This, however, is a common procedure performed for benign lesions of the bladder wall.
  • Simple cystectomy: In this procedure, the entire bladder is removed; however, the surrounding fatty tissue and pelvic organs are preserved. This type of cystectomy is primarily performed for extensive benign lesions of the bladder which leave the bladder nonfunctional.

After the bladder is removed, the surgeon will then perform some type of urinary diversion to restore continuity of the urinary tract. This is most commonly performed with an ileal conduit which is a surgical procedure in which a small strip on intestine is removed from the intestinal tract and then brought to the skin surface. The ureters from the kidneys are then surgically attached to this intestinal strip. This allows urine from the kidneys to enter this segment of the intestine and subsequently be delivered through the skin stoma into a urinary collection bag.

There are a multitude of other types of urinary diversions which can also be performed based upon patient preference and disease states. Many of these diversions are designed to eliminate the need for an external drainage bag. In these surgeries, a larger strip of intestine is used to create a urinary pouch inside the body which then delivers the urine either through the urethra or through a small stoma through which the patient passes a catheter to drain urine intermittently throughout the day. Nationwide, continent diversions are performed less often due to the higher complication rates associated with this surgery as well as the increased demand placed upon patients for care of this type of diversion on a daily basis.

What are common symptoms following my cystectomy?

A cystectomy is a complex surgical procedure which can carry up to a 25% complication rate. Most of these complications are minor and can be effectively treated.

By the time you leave the hospital, you should be ambulating independently with good pain relief with oral pain medication. It is common to have pain in the incision site for several weeks following any major surgery.

Because of the use of pain medication around the time of your surgery, constipation is a common problem. Patients are advised to monitor themselves for this problem and to use over-the-counter stool softeners and laxatives as needed.

Easy fatigue is very common following this surgery and can last for weeks to months depending on the patient’s baseline health, age and overall endurance.

When should I seek advice from my physician?

Contact your physician is you run a fever of 101 degrees Fahrenheit or greater consistently. Your physician will also need to know if you are having any difficulty with abdominal pain or bloating that is not improved with pain medication. If you develop nausea and vomiting that persists greater than 24 hours, you should also contact your physician.

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