What is a radical cystectomy?
A radical cystectomy is a surgical procedure for the treatment of bladder cancer. The surgery involves making an incision in the lower abdomen and removing the bilateral pelvic lymph nodes, bladder, and in men the prostate gland and seminal vesicles, and in women the uterus and ovaries if present. The some cases, the urethra is also removed. The purpose is to remove all of the bladder cancer.
After the removal of the bladder, the ureter (tubes that drain the kidneys) must be re-routed into one of the possible sites:
1). An Ileal Conduit- A small segment of small intestine (ileum) is separated from the rest of the bowel. The ureters are sewn to one end of this tube of ileum. The other end of the ileal conduit is sewn to the abdominal wall. The opening on the skin is called a urostomy (drains only urine, not stool). You would wear an ostomy appliance (bag that holds the urine).
2). An Indiana Pouch- A portion of small and large intestines are separated from the rest of the bowel. They are sewn together to form a large pouch. Ureters are sewn to this pouch and as opening is constructed from the pouch to the abdominal wall skin. The opening is small and requires no bag. You must pass a catheter into the opening on the abdominal wall in order to empty the pouch when it is full of urine.
3).A Neo-bladder- A portion of small and/or large intestines are separated from the rest of the bowel. They are sewn together to form a large pouch. The ureters are sewn to the pouch, and the pouch is sewn to the urethra.
Not all of these options are available to all patients and may vary depending on your age, overall health status, and extent of your cancer.
A pathologist will receive all of the tissue removed at the time of surgery. A final report may take 2 to 7 days to receive, depending upon each hospital facility.
Before and after surgery:
Aspirin, anti-inflammatory drugs (Motrin, Advil, Ibuprofen, etc.) and platelet-inhibiting drugs (Ticlid, Plavix) should be stopped 10 days prior to surgery. Stop all herbal medications 10 days prior to surgery.
Some patients choose to donate their own blood to the American Red Cross prior to surgery for their use during surgery in the event that a transfusion is needed. This can be arranged through your urologist.
Your surgeon may order a complete bowel prep to be done the day prior to your surgery. You will either be admitted the day prior or the day of surgery depending on your insurance.
Following surgery you will initially go to the intensive care unit and subsequently to a regular hospital room after a day or two. Hospitalization normally ranges between 7 to 10 days. You may have a tube draining from your stomach after surgery. After the tube is removed, we will start your diet. Depending on the type of diversion you may be discharged with catheters and tubes in place. We advise no strenuous activities for 6 weeks.
What are the risks of this procedure?
There are numerous risks that accompany this surgery The likelihood of a complication is about 30% and the risk of dying from this surgery is 1-2%. These risks include, but are not limited to the following:
- Bleeding that may require transfusion.
-Infection: You will be given antibiotics to minimize this risk.
-Blood clot in the leg that travels to the lung: Compression stockings and early mobilization are used to minimize the risk after operation.
-Slow return of bowel function and possible bowel obstruction or internal urinary leak that could require more surgery.
-Urinary incontinence with a neobladder.
-Erectile dysfunction
-Cardiovascular problems including heart attack, stroke, or anesthetic complications
-Recurrence of caner: There may be a need for additional treatment with either chemotherapy or radiation therapy. With any treatment for bladder cancer there is a risk of recurrent cancer at a later point in time. This emphasizes the importance of lifelong follow-up with your urologist.
What are the alternatives to cystectomy?
Radical cystectomy is considered to be the gold standard for treatment of muscle invasive bladder cancer. However, there are alternative therapies, which include radiation therapy, chemotherapy, combination of chemotherapy and radiation therapy, and partial cystectomy. Your urologist will review the advantages and disadvantages with each approach. Your urologist will discuss whether these are suitable alternatives for you.