Cystectomy

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A cystectomy is the complete surgical removal of the urinary bladder. During this procedure, only the urinary bladder can be removed or other organs in the vicinity can be removed. Read all about the cystectomy process, when it is used, and the risks involved.

What is a cystectomy?

A cystectomy is the surgical procedure used to remove the urinary bladder. The entire urinary bladder and usually the associated lymph nodes are removed and reconstructed using various techniques. If other organs have to be removed in addition to the urinary bladder, doctors speak of a “radical cystectomy”. In men, this includes the removal of the urinary bladder, prostate and seminal vesicles. In a woman's radical cystectomy, in addition to the urinary bladder, the uterus, its appendages (adnexa) and the anterior wall of the vagina are removed.

The cystectomy can be carried out openly, i.e. through an abdominal incision, or through a probe (endoscopic cystectomy).

Reconstruction of the bladder after cystectomy

Since the bladder can no longer absorb the urine, the drainage of the urine must be ensured after the operation. In addition, procedures such as the neobladder or the ileum conduit are used.

When reconstructing with a neobladder, the doctor removes a section of the small intestine, which he sutures to the ureters and urethra in the position of the urinary bladder. An ileum conduit is an artificial tube made of parts of the small intestine through which the urine is passed through an opening in the abdominal wall into a pouch.

When is a cystectomy done?

The simple cystectomy, in which only the urinary bladder is removed, is necessary for the following diseases:

• Interstitial cystitis (chronic inflammation of the bladder)
• Chronic inflammation of the bladder after radiation (radiation cystitis)
• Superficial bladder tumors
• Dysfunction of the bladder that cannot be remedied by other therapies

The most common reason for a radical cystectomy is a malignant bladder tumor that is already growing into the muscle layer of the bladder wall.

What do you do with a cystectomy?

The urinary bladder is a hollow organ located behind the pubic bone. It serves as a collection point for the urine formed in the kidney. It can be divided into the following sections:

• Bladder tip (anterior upper bladder part)
• Bladder
• Bladder neck (with transition into the urethra)
• Bladder base (posterior lower bladder part)

Before the cystectomy

The anesthetist puts him under general anesthesia so that the patient can have the bladder removal asleep and pain-free. In some cases, regional anesthesia is sufficient for the cystectomy; here the patient is conscious but cannot feel any pain.

In the operating room, the surgeon carefully disinfects the operating area and covers it with sterile towels. The abdominal region is left out.

Simple cystectomy: the operation

The doctor opens the skin through an incision in the middle of the lower abdomen. This gives him a clear view of the intestinal loops, which the assisting surgeon holds aside with a hook. Now the surgeon removes the lymph nodes from the pelvic cavity. He wraps the blood vessels of the urinary bladder with a thread (ligature) and cuts them with a laser knife or scissors. Now the surgeon cuts the ureters just before they enter the urinary bladder. The bladder is gripped with special forceps, pulled towards the pubic bone and its anchoring in the tissue is severed.

Once the doctor has removed the organ, he carefully stops any bleeding by tying off the small vessels with a thread or by obliterating them - thus initiating artificial scar formation with special medication. The entire operation usually takes between two and a half to four hours. The reconstruction of the urinary bladder, for example with an ileum conduit, usually takes place during the same procedure.

After the cystectomy

After the cystectomy and bladder reconstruction, the doctor carefully sutures the subcutaneous fatty tissue with self-dissolving sutures. The skin is then closed with a suture or with metal clips and bandaged in a sterile manner.

What are the risks of a cystectomy?

The removal of the bladder is the standard procedure in the treatment of a bladder tumor growing in the muscle. As with any procedure, there are some surgical risks:

• Injury to the rectum
• Spread of tumor cells
• Lymphatic congestion
• Sluggishness (atony)
• Leaky seams (especially with ileum conduit systems)
• Formation of abscesses
• Incisional hernia
• Disturbed sexual function when the corresponding nerves are severed

In addition, the following problems can arise during a cystectomy:

• Bleeding during or after surgery
• Formation of a bruise, possibly requiring surgical removal
• Preservation of blood with a corresponding risk of infection
• Injury to nerves and soft tissues as well as surrounding organs
• Infections
• Allergic reaction to materials used (latex, medication and the like)
• Incidents of anesthesia
• Aesthetically unsatisfactory scar healing

What should I watch out for after a cystectomy?

Depending on how the bladder was reconstructed, there are a few rules to follow after a cystectomy. In general, the following measures apply to personal hygiene, medication and physical activity.

Body care after cystectomy

After the operation, the wound must not get wet to prevent infection. You should therefore not bathe or use the sauna for up to three weeks after the cystectomy. However, showering is allowed; Here it is advisable to carefully dab the wound dry with sterile compresses after showering. Alternatively, you can also use a special shower plaster from the pharmacy.

Post-cystectomy drugs

After the operation, the risk of blood clots (thrombosis) is increased.On the other hand, your doctor will prescribe blood-thinning medication (heparin), which you have to inject up to about four weeks after the procedure. After a short briefing by the doctor, the heparin syringes are easy to use.

There is noticeable pain in the wound, especially in the first few days after the operation. If necessary, your doctor will prescribe you a pain reliever medication.

In the first two weeks after the cystectomy, you should take it easy and do only little strenuous activities (walking, simple exercises).

Special measures depending on the reconstruction of the bladder

If your bladder has been reconstructed with an ileum conduit, you should change the urine collection bag regularly. You can discuss exactly how this works with specially trained stomatotherapists.

If you received a neobladder after the cystectomy, you should not cycle for the first twelve weeks in order to protect the inner wound sutures and should regularly perform the exercises for pelvic floor exercises you learned during your stay in hospital for at least six months. Please make sure to increase the time intervals between urination. This is necessary because your new bladder is still relatively small and only has to be expanded to a larger capacity by slowly increasing amounts. To avoid overflowing at night, it is advisable to empty your bladder again before going to sleep.

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