Cystectomy is the medical term for surgical removal of all or part of the bladder. It may also be rarely used to refer to cyst removal. The most common conditions that ensure the removal of the bladder are bladder cancer.
Two main types of cystectomies can be performed. A partial cystectomy (also known as segmental cystectomy) involves removal of only a portion of the bladder. A radical cystectomy involves removing the whole bladder along with surrounding lymph nodes and other organs surrounding it that contain cancer.
Network evaluation is removed during cystectomy and lymph node dissection in determining pathological cancer staging. This type of staging of cancer can be used to determine the further work, treatment, and follow-up required along with the potential prognosis.
After the bladder is removed, urine transfer is necessary to allow for urine elimination.
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Malignancy
Radical systectomy is the recommended treatment for bladder cancer that has invaded bladder muscle. Cystectomy can also be recommended for individuals with a high risk of developing cancer or cancer failure to respond to a less invasive treatment.
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Type
When determining the type of cystectomy to be done many factors are considered. Some of these factors include: age, overall health, basic bladder function, type of cancer, location and size of the cancer, and the stage of cancer.
Partial cystectomy
Partial cystectomy involves removal of only a portion of the bladder and is performed for several benign and malignant tumors that are localized to the bladder. Individuals who may be candidates for a partial cystectomy include those with a single tumor located near the dome, or upper, of the bladder, a tumor that does not invade the bladder muscle, a tumor located inside the bladder diverticulum, or non-carcinoma cancer in situ CIS). Partial cystectomy may also be performed to remove tumors originating and spreading from neighboring organs such as the large intestine.
Radical cystectomy
A radical cystectomy is most often performed for a cancer that has invaded into the bladder muscle. In radical cystectomy the bladder is removed along with surrounding lymph nodes (lymph node dissection) and other organs containing cancer. In men, this may include prostate and seminal vesicles. In women, this may include some of the vagina, uterus, fallopian tubes, and ovaries.
Technique
Open
In an open radical cystectomy, a large incision is made in the middle of the abdomen from just above or next to the umbilicus to the symphysis pubis. The following information provides general steps for this procedure and can occur in various sequences depending on the surgeon. Ureter is located and cut free from the bladder. The bladder is separated from the surrounding structure and removed. Urethra, which drains urine from the bladder, can also be removed depending on tumor involvement. In men, the prostate may or may not be excluded during this procedure. Lymph node dissection of the pelvic (PLND) is performed. The urine transfer is then made and the free end of the ureter is reconnected to the transfer.
Minimally invasive
A minimally invasive radical cystectomy more commonly known as radical laparoscopically assisted radical cystectomy (RARC) may be an option for individuals depending on several factors including but not limited to: their overall health (with particular attention to their lung health), body mass index (BMI), number and type of previous surgery, along with the location and size of bladder cancer. In RARC some small incisions are made throughout the abdomen to allow the placement of surgical instruments. These tools are then connected to a surgical robot controlled by a surgeon. The position of the lower head (Trendelenburg) is used and the stomach is pumped with gas (insufflation) to allow the operating room and better visualization. The rest of the procedure is performed in a manner similar to an open procedure.
Contraindications
Generally, there is no specific contraindication to have a cystectomy. However, cystectomy should not be performed on individuals who are not well enough to undergo major surgical procedures. These include individuals who can not tolerate general anesthesia or those with severe or unmanaged co-morbidities such as diabetes, heart, lung, kidney, or liver disease. It also includes individuals who are highly malnourished, have problems with blood clots, or severe laboratory abnormalities. Also, individuals with active disease or infection should delay surgery until recovery.
Surgery with the help of robotics or laparoscopy is contraindicated for individuals with severe heart and lung disease. During this method of operation position and abdominal insufflation puts additional strain on the chest wall impairing the function of the lungs and the ability to oxidize blood.
Partial cystectomy is contraindicated in the form of a bladder cancer called carcinoma in situ (CIS). Other contraindications to partial cystectomy include a significantly reduced bladder capacity or cancer near the bladder trigonum, where the urethra and ureter are connected to the bladder.
Risks and complications
Radical cystectomy with the formation of urine transfer may be associated with some risks and complications due to the extent and complexity of the operation. Like most major surgeries, there is a risk of anesthesia, as well, the risk of bleeding, blood clotting, heart attack, stroke, and pneumonia or other respiratory problems. There is also a risk of infection involving the urinary tract, stomach, and gastrointestinal tract. After surgical incision is closed, there is a risk of infection in these places.
Similar complications between open and minimally invasive cystectomy techniques and include the following:
Gastrointestinal tract
An ileus, in which movement in the intestine slows is the most common complication after cystectomy. This is due to various factors including intestinal manipulation due to its proximity to the bladder, the actual operation of the intestine to create a urinary diversion, or even certain drugs such as narcotics. In addition to slowing the small intestine, the small intestine can also become obstructed. After the creation of a urinary transfer, the intestinal contents may leak in places where the intestines will be reconnected.
Urinary tract
With the creation of a urine diversion it is possible for the ureter to be prevented from preventing urine drainage from the kidneys. If this happens, other procedures for insertion of nephrostomy tube demands may be necessary to allow drainage of urine from the body. Ureter obstruction is most common in places where the ureter is reconnected to a urinary transfer made. A small, hollow, and flexible tube called a stent can be placed inside the ureter at the time of surgery to possibly help the reconstruction site to heal. This reconection site is also at risk of leaking urine in the stomach.
If partial cystectomy is performed, ureteric damage can occur depending on the location of the removed tumor. This may require additional procedures to correct.
Nerve injury
Because of the location of surgery, nerve damage in the pelvis can occur during the lifting of the bladder or lymph nodes. The nerves in this area are responsible for movement and leg sensation and include the obturator nerve, the genitofemoral nerve, and the femoral nerve.
One of these complications may require another surgery or re-entry to the hospital.
Recovery
Diet
Immediately after the operation no food or drink is allowed due to digestive tract involvement in surgery. The diet will slowly progress to the liquid and then solid foods as tolerated. If gastrointestinal complications such as nausea, vomiting, or flatulence occur diet may be stopped or progress of the diet slows down depending on the severity.
Pain control
Intravenous pain medications such as narcotics are usually used immediately after surgery. Pain medications can be transferred to oral form after the diet is tolerated.
Activity
Initial activity is recommended after surgery. Individuals may be able to walk and sit in seats as early as the same day of operation. Usually an individual can walk around the room or hospital ward within a day or two after surgery. Some individuals may require additional help or physical therapy at the hospital or after returning home.
Prevention of venous thromboembolism
The approach to prevent venous thromboembolism (VTE) is performed both before and after surgery. The compression device is placed around the foot or drugs such as Heparin or low molecular weight heparin (LMWH) commonly used. VTE prophylaxis with LMWH can even be continued after discharge from the hospital if necessary.
Follow-up operations
If open cystectomy is performed, the staples that close the incision are usually removed 5 to 10 days after surgery. Further follow-up with a surgeon is usually scheduled 4 to 6 weeks after surgery and may involve laboratory or imaging to assess recovery along with further treatment and follow-up.
References
External links
- American Bladder Cancer Society A site created for and by people with bladder cancer (BLC), people with symptoms and people who care about them. A support group that promotes education, awareness, and discussion forums to help patients, survivors and carers share information and get answers to questions.
- Information at Cafe Web Bladder Cancer
- About the reconstruction of Stanford Hospital
- Scientific paper on neobladders
Source of the article : Wikipedia
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