Yes, talking about cystectomy isn’t a walk in the park, but it’s our job to keep you in the know. The bladder is a muscular sac in the pelvis, about the size of a pear when empty with a capacity somewhere between 400 and 600ml when full. It receives urine from the kidneys and stores it for excretion.
Aside from cancer, a cystectomy may also be required to treat injuries to the bladder, neurological conditions affecting the urinary system, and birth defects that affect the urinary system.
A partial cystectomy removes only the areas of the bladder where cancer is found. This allows for the remainder of the bladder to be preserved.
A radical cystectomy involves the removal of the entire bladder, nearby lymph nodes, part of the urethra, and any other nearby tissue that may contain cancer cells. This is the most common operation for muscle-invasive bladder cancer. In men, the prostate, urethra, and seminal vesicles may also be removed. In women, the urethra, uterus, ovaries, fallopian tubes, and a portion of the vagina may also be removed.
A cystectomy is performed with the patient under general anesthesia. That way, you won’t have to feel, think, or worry about what’s happening. The procedure is executed either as open surgery, laparoscopically, or robotically.
The procedure can be performed using open surgery where a single incision is made to access the bladder.
Laparoscopy uses three or four small abdominal incisions and fibre-optic technology to operate and is far less invasive than open surgery. As such, the recovery time is much quicker. The bladder is detached internally, then removed through one of the incisions.
Robotic surgery is also minimally invasive. Robotic-assisted instruments are inserted through the incisions and controlled by a surgeon. This allows for far more precise movement of the surgeon’s hands meaning it is an even less invasive procedure overall.
If the bladder is removed entirely, the urinary tract will need to be reconstructed for the proper urinary function to return. This may involve a number of procedures:
Orthotopic continent urinary diversion – a piece of the intestine is used to create a tube that runs from the kidneys to a small reservoir that is connected to the urethra. This allows close to normal urinary function.
Urinary conduit (urostomy) – a piece of the intestine is used to create a tube that runs from the kidneys to the abdominal wall. A bag worn on the abdomen is used to collect the urine.
The reconstructive procedure used will depend on a few factors including the reason for surgery, your health, and your personal preferences. Read more about urinary diversion here.
Dr. Arianayagam is one of Sydney’s best urologists, but regardless of skill, radical cystectomy can still sometimes involve some complications. Short term problems may include bowel obstruction or kidney infection. Long term complications include kidney problems (such as renal failure), abdominal obstructions, issues with the reconstructed urinary tract, or scar tissue forming in the intestine, but these are worst-case scenarios.
Other side effects may include infertility (if a woman’s uterus or ovaries, or a man’s prostate gland is removed during the surgery), erectile dysfunction, and premature menopause.
Following the procedure, patients are taken to recovery and monitored closely, to ensure there are no further issues. Most patients will be required to stay in the hospital for more than 5 days. During this time, they will be given pain medication, injections to reduce the risk of clots as well as intensive physiotherapy, to help soothe tensions.
Once stable, patients can drink liquids. This will progress to a more advanced diet as their condition improves. Patients are encouraged to begin walking a soon as possible to help prevent complications.
Once home, patients are encouraged to stay active, although strenuous exercise, heavy lifting, or excessive stair climbing is not recommended for at least 6 weeks. Driving is also discouraged for 3-4 weeks after surgery.
Dr. Arianayagam is an expert in robotic surgery and performs all radical cystectomies with the da Vinci robot. He performs the urinary diversion (conduit or neobladder) inside the body (intracorporeal).
Robotic cystectomy may hasten recovery and shorten hospital stay. It may also improve the return of sexual function. Robotic cystectomy is associated with reduced blood loss as well, so there are many positives to this particular method. Patients may have their robotic cystectomy performed at either Nepean public hospital or Macquarie University Hospital.
If you have any questions regarding cystectomy or would like to book an appointment, please feel free to contact Urology Specialist here.
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