Cystectomy is a surgical procedure in which all or part of the urinary bladder is removed. The urinary bladder is the muscular organ which collects urine from the kidneys for excretion. A Simple Cystectomy involves removing the entire bladder while a Radical Cystectomy involves removing the bladder as well as other pelvic organs. In a Partial or Segmental Cystectomy, only a part of the bladder is removed.
This procedure is commonly performed to treat cancer of the bladder. A partial or simple cystectomy is used to treat superficial tumors isolated to the inner lining of the bladder. Radical cystectomy is the standard treatment for cancer that has spread to the bladder muscle. A cystectomy may be performed if there is a chronic inflammation of the bladder, endometriosis that has spread to the bladder, severe urinary dysfunction, damage to the bladder from radiation or other treatments or excessive bleeding from the bladder.
Partial Cystectomy
During partial or segmental cystectomy, only the specific cancer affected area of the bladder is removed thus preserving most of the bladder. In such cases the cancer must not have spread to the bladder muscle and must be isolated to one area. Partial cystectomy is only used for such patients.
Procedure
After an incision is made into the lower abdomen, the bladder is identified and isolated. The surgeon may choose to perform the operation with the bladder remaining inside the abdominal cavity or with the bladder lifted outside of the abdominal cavity. The cancerous area is cut out with an additional margin of 2 cm to ensure that all cancerous cells are removed. The bladder is then closed with stitches. The pelvic lymph nodes may also be removed during the procedure. After the cancerous tissue is removed, it is examined by a pathologist to determine if the margins of the tissue are clear of abnormal cells.
Simple and Radical Cystectomy
Simple and Radical Cystectomy involves removal of the Bladder, unlike Partial Cystectomy where only a part of the bladder is removed.
In the case of a Radical Cystectomy, other pelvic organs and structures are also removed since the cancer may have spread to the surrounding tissues. General anesthesia is administered to the patient after which an incision is made into the lower abdomen. Blood vessels that enter and leave the bladder are tied up. The bladder is then divided from the urethra, ureters and other tissues, holding it in place. The bladder can then be removed.
Procedure
The surgical procedure for radical cystectomy differs between male and female patients. In men, the prostate, seminal vesicles, and pelvic lymph nodes are removed with the bladder. In women, the uterus, fallopian tubes, ovaries, front part of the vagina, and pelvic lymph nodes are removed with the bladder. If the surgery is being performed as a treatment for cancer, the removed tissues may be examined for the presence of abnormal cells.
A new method for excreting urine has to be created after removal of the bladder. One commonly used approach is the ileal conduit. A piece of the small intestine is removed, cleaned, and tied at one end to form a tube. The other end is used to form a stoma, an opening through the abdominal wall to the outside. The ureters are then connected to the tube. Urine produced by the kidneys flows down the ureters, into the tube, and through the stoma. The patient wears a bag to collect the urine.
A pouch is constructed, made out of portions of the small and large intestine and the ureters are connected to the pouch. A stoma is then created through the abdominal wall. Urine is removed by inserting a thin tube, known as the catheter, into the stoma when the pouch is full.
Alternatively, a similar pouch called a neobladder can be created, attached to both the ureters and the urethra, in an attempt to preserve as close to normal bladder function as possible.
Fluid based nutrition s given to the patient until the intestines function normally again. Antibiotics are also given to prevent any infection. There will definitely be major lifestyle changes once for the person undergoing a cystectomy. Men may become impotent if nerves controlling penile erection are cut during the removal of the bladder. Women can become infertile as well, since the uterus along with the ovaries and fallopian tubes would be removed (in the case of a radical cystectomy). It has been noted however, that most women who undergo this surgery are postmenopausal.
An external bag is attached to the patients which connects to the stoma and helps in collection of urine from the kidneys. The bag is generally worn around the waist under clothing. Since there is no bladder, urine gets excreted as it is produced. The stoma should be taken care of meticulously ensuring that it does not get infected or blocked.
Risks
As with any major surgery there are risks involved.Infection of the intestine which can lead to peritonitis,In the case of a partial cystectomy there is a risk of urine leakage from the incision site.Injury to surrounding organs Complications associated with general anesthesia Excessive blood loss, Sexual Dysfunction, Incontinence
Recovery
A successful partial cystectomy ensures that the cancerous site of the bladder is removed and the patient retains urinary control. A successful simple or radical cystectomy ensures that an alternate urinary diversion is made once the bladder is completely removed with little or no effect on sexual function. Intestinal function slowly returns to normal and the patient is taught how to take care of the stoma and bag.
