Cystectomy: Partial or Full Bladder Surgery

A full or partial surgical removal of the urinary bladder is called Cystectomy. The urinary bladder stores urine before you pass it from your body. The most common reason to have this surgery is to treat invasive bladder cancer

Cystectomy is a surgery to remove the urinary bladder.

1. In men, removing the entire bladder (radical cystectomy) typically includes removal of the prostate and seminal vesicles.
2. In women, radical cystectomy also involves removal of the uterus, ovaries and part of the vagina.

1.  Your doctor uses bladder removal surgery to remove cancerous tissues.
2. The main benefit is that you have an improved chance of recovering from bladder cancer.

This surgery is generally carried out to treat bladder cancer.

The causes of bladder cancer include:

1. Smoking tobacco as it contains cancer-causing (carcinogenic) chemicals.
2. Exposure to certain industrial chemicals, such as aniline dyes, and 2-Naphthylamine.
3. Work involving dyes, textiles, rubbers, paints, etc. 
4. Radiotherapy for other cancer treatments. For example, previous treatment with some chemotherapy medications, such as cisplatin and cyclophosphamide.

Your doctor might recommend a cystectomy for the following conditions:

1. Cancer that spreads quickly or muscle-invasive tumour.
2. Non-cancerous or Benign disorders affect the bladder and urinary system.
3. Aggressively growing or multifocal tumour.
4. If you are suffering from an incurable disease and have symptoms such as pain and bleeding.
5. Recurring tumours, cannot be treated by chemotherapy or immunotherapy.
6. Failure of chemoradiation (bladder-sparing approach).
7. Failure of intravesical therapy (administration of a drug directly into the bladder).
8. For the long-term survival of the patient.

You should call your doctor right away if you notice the following symptoms of bladder cancer:

Haematuria: 

Haematuria is the presence of blood in the urine. The presence of blood can turn the urine orange, pink or dark red. This blood may disappear for some days, but it reappears in case of bladder cancer. Earlier stages of bladder cancer are characterized by bleeding without pain and other symptoms.

Irritation or changes in the bladder:

1. Bladder cancer can cause changes in urination, such as:
2. Frequent urination 
3. Urge to urinate, even  when your bladder isn't full
4. Burning sensation during urination
5. Need to urinate more than usual at night.

Symptoms of advanced bladder cancer:

1. Pain on one side of the lower back
2. You are unable to urinate
3. Oedema (swelling) of feet
4. Weight loss or loss of appetite
5. Pain in the bones.

What Will Happen if Surgery Is Delayed?

1. If cystectomy is delayed, severe outcomes can be expected, such as: Fast-growing non-invasive papillary tumour. 
2. Cancers that return as more serious, growing into deeper layers or those which spread into other tissues.
3. Development of stage-1 bladder cancer that grows inside the connective tissue layer of the bladder wall.
4. If the cancer is not treated in stage one, it develops into stage-2 bladder cancer, invading the muscle layer of the bladder wall.  
5. Untreated stage-2 bladder cancer can develop into stage 3, spreading outside the bladder, lymph nodes and nearby tissue and organs.
6. In stage-4, cancer invades the pelvic and abdominal walls and spreads into distant parts of the body. In stage 4, it is hard to get rid of cancer completely.

What to Expect After Surgery?

The recovery process in hospital:

1. Post-surgery, you will be placed in the recovery room. You will be given medication to relieve any pain.
2. Most patients will be transferred to a regular hospital room, while some may remain in the intensive care unit (ICU).
3. Days following the surgery, you will be closely monitored. 
4. To prevent blood clots after the surgery, medicines will be provided for up to four weeks.
5. Your doctor will explain in detail the post-operative routine.
6. Two temporary stents (plastic tubes) might be visible on the outside for drainage of the urine from the kidneys. 
7. If you have a neo-bladder or continent diversion, you will also have one to two catheters to drain the bladder.
8. With an ileal conduit, you might only have an appliance placed over the small opening near the belly button called the stoma.
9. The doctor will teach you how to control the neobladder and empty the internal urine bag, before setting a date for your discharge.

Recovery process/expectation after hospital discharge:

1. You may experience some discomfort and pain for a couple of weeks after surgery. 
2. You can ask your doctor about ways to manage pain.
3. Your physical activities will be limited after surgery, but it is essential to stay active through light activities like walking to aid recovery. 
4. Do not lift more than five kg (about the weight of a house cat). 
5. Ask your doctor when it’s safe to resume sexual activities. Typically, you should wait at least six weeks before sexual intercourse.
6. The incision site should not be exposed to water. After some time, you will get accustomed to the stoma. 
7. Some challenges, such as leaking from their bag, may persist. Before discharge, talk with your doctor about how to care for the incision site.

The changes expected in men and women after the cystectomy:

In men:

1. As the prostate will be removed, you will not be able to conceive you’re your partner by sexual intercourse. 
2. Your ability to have an erection may be affected. Cystectomy can injure the nerves that regulate erection. Consult with your doctor before surgery if you have questions about fertility.

In women:

1. The labia and clitoris are not removed, and some parts of the vagina will usually be left, so most women will still be able to have intercourse.
2. The doctors will provide specific diet recommendations at the time of discharge. Nevertheless, the intestines can slow down after this type of surgery, so it is best to eat shorter, more frequent meals and drink plenty of fluids up until your initial follow-up appointment.

First Follow up Appointment

1. You must remember the following:
2. Schedule your post-operative appointment with the doctor two to three weeks after discharge from the hospital.
3. Your doctor will routinely arrange check-ups at the clinic to observe if cancer has returned.