This is a surgical procedure where:
In men the bladder is removed, together with the prostate gland and seminal vesicles.
In women the bladder, uterus, ovaries, urethra and anterior vaginal wall are removed.
Cystectomy is the procedure which is recommended for patients with non-metastatic muscle-invasive bladder cancer.
It is also selected for patients with large bladder tumors which it is not possible to remove through the urethra, or in cases of uncontrolled hematuria (blood in the urine) from the bladder.
On admission to the hospital, a pre-operative assessment is carried out which includes:
- Blood tests
- Urine tests
- Chest X-ray
- Cardiac assessment
In the event that a patient is on anticoagulant (blood thinning) medication, it is necessary to stop taking this or to substitute it with an alternative, a few days prior to the surgical procedure.
How radical cystectomy is performed
The procedure is performed under combined general and epidural anesthesia.
First, the patient is placed in a supine position, and a thorough antiseptic cleansing of the abdominal area is performed.
Then, through an incision which starts from the pubic symphysis and reaches to just above the navel, the regional lymph nodes and bladder are removed.
For urine collection following cystectomy various techniques exist.
The most common is to divert the urine to exit the body through a stoma which is created in the wall of the abdomen.
Another option is to create a neobladder using the intestine so that the patient is able to urinate through the urethra.
At the end of the procedure a tube drain and catheter are placed.
After the procedure
During the first 24 hours following the procedure the patient may require monitoring in an intensive care unit.
In the subsequent days of hospitalization it is essential that the patient mobilize and start to eat after the restoration of intestine functioning.
During the hospital stay, specialized staff instruct the patient in changing the stoma bag and caring for the stoma.
At discharge instructions are provided regarding:
- Antibiotic medication to take at home
- Receiving histological test results
- How long to avoid strenuous physical activity
- Time of re-examination and the surveillance plan with medical imaging
Radical cystectomy is a major procedure and length of time in hospital is estimated to be one to two weeks on average.
Following the procedure most patients develop erectile dysfunction and are unable to have children.
Depending on the result of the histological test, adjuvant chemotherapy may be required.