Perhaps you or someone in your family has been told by a doctor that you will need to have your bladder surgically removed, either due to bladder cancer or another long-term condition. It is normal to feel a great deal of fear and anxiety when you hear the word 'Cystectomy'. But today, let's be more aware of this. What is this surgery? Why is it done? What happens afterwards? Let's talk about all this very simply.
What kind of surgery is a cystectomy?
Simply put,
a cystectomy is a surgical procedure to remove part or all of your bladder. As you know, the bladder is a ball-shaped organ that collects and stores urine (pee) produced by our kidneys. This surgery is usually done as a treatment for bladder cancer. However, sometimes doctors decide to perform this surgery for other non-cancerous (benign) conditions as well. This is not a minor surgery, but
a major surgery . Because it removes an important organ in our body, the bladder.
Is it possible to live without a bladder?
Yes, you can. You may be surprised to hear this, but it is possible to live without a bladder. But then you will have to find a new way to excrete the urine produced by our kidneys. If the doctor removes the entire bladder, it will take some time for you to get used to the new system. But don't worry, you will be able to do most of the things you did before the surgery, even after the surgery.
What should you know before undergoing cystectomy surgery?
Before the surgery, your doctor will examine you and check your general health. He will also explain to you what type of surgery he will be performing. There are several types of this surgery.
- Partial Cystectomy : This involves removing only the diseased part of your bladder. If this is done because of cancer, the surrounding lymph nodes are also removed and checked to see if the cancer has spread. The remaining part of your bladder is then stitched back together to restore normal function.
- Simple Cystectomy (removal of only the bladder): This involves removing only the bladder without damaging the surrounding organs. This is usually done for non-cancerous conditions. For example, urinary problems caused by nerve damage ( neurogenic bladder ), radiationConditions such as radiation cystitis and urinary fistula caused by treatment.
- Radical Cystectomy (removal of the bladder and surrounding organs): In this, the bladder is completely removed, as well as the surrounding lymph nodes.
- In the case of a man, the vas deferens are usually cut, and the prostate and seminal vesicles are removed.
- In women, the uterus, fallopian tubes, ovaries, and cervix are often removed. Sometimes, part of the vaginal wall may also be removed.
It is important to tell your doctor about all the medications you are taking (prescribed, over-the-counter, and even herbal products) before your surgery. Some medications, especially blood thinners, can increase the risk of bleeding during surgery. So do not stop taking any medications without your doctor's advice.
How is the surgery done?
This surgery is performed by a team of doctors led by a urologist. You will be given general anesthesia, so you will not feel any pain and will be asleep. There are two main methods of performing the surgery: 1.
Open Cystectomy: In this, a 6-7 inch incision is made between the navel and the perineum, through which the doctor performs the surgery. 2.
Minimally Invasive Cystectomy: This can be done laparoscopically or robotically. This involves making 5-6 very small incisions in the abdomen, through which a camera and delicate instruments are inserted. The advantage of this is that there is less scarring and the healing time is shorter.
How to make a new way to urinate
After the entire bladder is removed, a new path for urine to exit the body must be created. This is called 'reconstructive surgery.' There are three main methods for this.
| Reconstruction Method | What simply happens |
|---|
| Ileal Conduit | A small piece of the small intestine is taken and the ureters are connected to one end. The other end is attached to the skin of the abdomen, opening into a hole called a stoma. An ostomy bag is placed over the stoma to collect urine. |
| Continent Cutaneous Diversion | Parts of the small and large intestines are used to create a small bag (reservoir) inside the body that collects urine. This is also connected to the skin of the abdomen by a stoma. But there is no external bag. Several times a day, a small tube (catheter) is inserted to empty this bag. |
| Neobladder | A long piece of small intestine is taken and used to create a new bladder (Neobladder). This is connected directly to your urethra. So you can urinate normally. But you have to contract your abdominal muscles to pass urine. Some people need to use a catheter to completely empty it. |
Your doctor will discuss with you and decide which method is best for you.
What to expect after surgery?
After the operation, you will be transferred to the ward. The incisions will be bandaged. You will be given pain medication. The length of your stay in the hospital will vary depending on the type of surgery you had. For a minor incision, you will stay in the hospital for a day or two, and for an open surgery, you will stay in the hospital for about a week. During this time, the nursing staff will take good care of you. If you have an ostomy bag, you will be taught how to use, empty, and change it. It can take
a few weeks to a few months to fully recover.
What are the risks of this surgery?
Like any major surgery, this one has some risks.
- Bleeding
- Blood clotting
- Infections
- Intestinal problems (constipation, diarrhea)
- Urinary obstruction due to scar tissue
- Damage to other organs
- Fluid accumulation at incision sites (seroma)
Some men may have problems with erection. Women may experience difficulty with sexual intercourse if part of the vagina is removed. Don't be afraid to talk to your doctor about these sexual problems.
If you experience any of the following symptoms after your surgery,
notify your doctor immediately or go to the nearest hospital's
Emergency Department (ETU) .
Warning signs to look out for
| Signs of infection | Fever, chills, dark or cloudy urine. |
| Problems at the incision sites | Excessive bleeding, swelling, pain, or increased pus discharge. |
| Stoma problems | The stoma is black, brown, or dark purple. |
| Other serious symptoms | Persistent nausea and vomiting, unbearable pain, inability or difficulty urinating. |
Take-Home Message
- Cystectomy is a major, life-saving surgery performed for conditions such as bladder cancer.
- It is possible to live without a bladder. There are various reconstructive methods to help the body release urine. Talk to your doctor about the best option for you.
- It takes time to adjust to the changes in your body after surgery. This is normal. Don't hesitate to get the emotional and physical support you need.
- During recovery, it is very important to seek immediate medical advice if any warning signs arise.
- With proper management and a positive attitude, you can maintain a good quality of life even after surgery.
Cystectomy, bladder removal, bladder cancer, urostomy, ostomy bag, neobladder, surgery, urology, urine
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