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by Kohnle D

Cystectomy

(Radical Bladder Removal, Partial Bladder Removal)

Definition

A cystectomy is a surgery to remove all or part of the bladder:
  • A radical cystectomy removes all of the bladder, nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells.
  • A partial cystectomy removes part of the bladder.

Reasons for Procedure

Reasons for a cystectomy include:

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Infection
  • Bleeding
  • Loss of sexual function
  • Fluid build-up in the abdominal cavity
  • Damage to other organs
  • Blockage of urine flow from the ureters to the bladder
  • Nutrition problems, depending on the bowel segments used to create a way for urine to drain
  • Blood clots
  • Reaction to anesthesia
  • Urinary incontinence
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
Previous surgery in the abdomen or pelvis, or radiation to the area increases your risk of complications.

What to Expect

Prior to Procedure

You may need to take antibiotics to prevent infection and laxatives to clean out your bowels.
The night before, you may be asked not to eat anything and to only drink clear liquids. Do not eat or drink anything after midnight or on the morning of the procedure. This includes avoiding clear liquids, coffee, tea, and water.
Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.

Anesthesia

General anesthesia is given before surgery. You will be asleep.

Description of Procedure

An incision will be made in the abdomen to expose the bladder. In a radical cystectomy, all blood vessels to the bladder will be cut. The bladder will then be removed along with nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells. In men, the prostate and glands that help produce semen will also be removed. In women, the uterus, ovaries, and, sometimes, part of the vagina will be removed.
The doctor will also need to create a new way for urine to be passed out of the body. A new bladder may be built using pieces of intestine or an external bag may be attached to the abdomen.
In a partial cystectomy, only part of the bladder will be removed.
Either procedure can be done by laparoscopic or robotic-assisted laparoscopic techniques using a number of smaller incisions and a camera.
Kidneys, Ureters, and Bladder
The Urinary System
Copyright © Nucleus Medical Media, Inc.

How Long Will It Take?

About 3–6 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 5-12 days. The specific length of time will depend on your condition and the reason for surgery. Your doctor may also choose to keep you longer if complications occur.

Post-procedure Care

At the Hospital
  • A stay in the intensive care unit may be needed.
  • Be encouraged to walk with assistance soon after surgery
  • During surgery, a tube will be placed from the nose to the stomach. It will stay there for several days. Because you cannot eat with the tube in place, you will receive IV fluids.
  • If a urine bag was attached during the surgery, you will be taught how to dispose of urine.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
You may have to restrict some of your activities while you recover. This may take 4-6 weeks. Home care may include:
  • Caring for your surgical wound
  • Exercises to strengthen your pelvic floor
  • Physical therapy or rehabilitation

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, heavy bleeding, or discharge from the incision and/or stoma site
  • Persistent nausea and/or vomiting
  • Pain that you cannot control with the medications you were given
  • Inability to urinate or difficulty urinating, extreme cloudiness or pus in the urine, a bad odor to the urine
If you think you have an emergency, call for medical help right away.

RESOURCES

National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

Urology Care Foundation http://www.urologyhealth.org

CANADIAN RESOURCES

Canadian Urological Association http://www.cua.org

Public Health Agency of Canada http://www.phac-aspc.gc.ca

References

Aboumarzouk OM, Drewa T, et al. Laparoscopic radical cystectomy: A 5-year review of a single institute's operative data and complications and a systematic review of the literature. Int Braz J Urol. 201238(3):330-340.

Bladder cancer facts. AP John Institute for Cancer Research website. Available at: http://www.apjohncancerinstitute.org/cancer/bladder.htm. Accessed May 29, 2014.

Cystectomy information binder. Johns Hopkins Medicine website. Available at: http://urology.jhu.edu/bladder/Cystectomy.pdf. Accessed May 29, 2014.

Liss MA, Kader AK. Robotic-assisted laparoscopic radical cystectomy: history, techniques and outcomes. World J Urol. 2013;31(3):489-497.

Maffezzini M, Campodonico F, et al. Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. Surg Oncol. 2008;17(1):41-48.

Revision Information

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