Want to know about cystectomy? Don't be afraid, let's talk!

When you hear that the entire bladder will be surgically removed, everyone is a little scared, right? "How will I urinate then?", "Can I live without a bladder?" Many questions probably come to your mind. But don't worry. This is not as scary as you think. Because medical science is advanced, there are solutions to all of this. Let's talk about everything simply, step by step.

What is a cystectomy?

Simply put, a cystectomy is a surgical procedure to remove your bladder. Your bladder is a flexible, sac-like organ that can hold about two cups (about 500 milliliters) of urine. This surgery is often performed as a treatment for bladder cancer. However, it can also be a solution for other bladder conditions.

The biggest question you may be asking now is, "Can you live without a bladder?"

Who needs this surgery?

There are several main reasons for having a cystectomy. This surgery may be performed for cancerous conditions as well as other non-cancerous conditions.

What are the types of cystectomy surgeries?

Depending on your condition, part or all of your bladder may be removed. There are three main types of surgery.

Partial Cystectomy (removal of part of the bladder)

This involves removing only the diseased part of the bladder. The remaining part can be used to collect urine. However, after the surgery, the bladder will be smaller than before. This is not a very common surgery.

Simple Cystectomy (removal of only the bladder)

This surgery only removes the bladder, not the other organs surrounding it. This surgery is often performed for non-cancerous conditions.

Radical Cystectomy (removal of the bladder and surrounding organs)

This is the most common type of surgery, especially for cancer. It involves removing the bladder along with other organs and tissues around it. This can cause damage to the sensory nerves that run near the bladder, which can affect sexual function.

• If this surgery is performed on a man , the doctor may remove parts such as the bladder, part of the urethra, prostate gland, seminal vesicles, and vas deferens.
• If a woman has this surgery, her bladder, urethra, part of her vagina, uterus, cervix, and ovaries may need to be removed. However, doctors try to save the vagina, uterus, and ovaries whenever possible. It is important to talk to your doctor about what is best for your situation.

How the surgery is performed and new methods of urination

Cystectomy is a major surgery that takes about 3-6 hours. It can be done as open surgery or as minimally invasive or robotic surgery.

After surgery, a new route (urinary diversion) is created for urine to exit the body. There are several main methods for this:

• Ileal Conduit: This is the most commonly used method. In this procedure, a section of the small intestine is taken, shaped into a tube, and the ureters from the kidneys are connected to it. The other end of the tube is then attached to a small opening (stoma) made in the skin of the abdomen. Urine comes out of the opening and collects in a special bag (urostomy bag) that is attached to it.
• Continent Cutaneous Diversion: Here, a pouch is created inside the body from a section of the intestine that collects urine. This pouch is also connected to an opening (stoma) on the skin. However, urine does not come out on its own. Every 4-6 hours, you have to insert a catheter and empty the pouch yourself.
• Neobladder (creating a new bladder): If your urethra is in good condition, a new bladder can be made from a section of the intestine and transplanted into the same place where the old bladder was. It is then connected to the urethra. You can then urinate normally. However, sometimes you may need to use a catheter to completely drain your urine.

Recovery and care after surgery

You will need to stay in the hospital for about 5-7 days after the surgery. It may take several weeks or months to fully recover. There are a few things you need to be aware of during this time.

• Drink plenty of water: Keep your body hydrated. It is also a good idea to take a drink like ORS along with water.
• Take a light walk: Walking a little every day after surgery is good for blood circulation and helps you heal faster.
• Keep your bowels active: After surgery, your bowels may become a little less active (ileus). The best thing to do for this is to drink fluids and walk around.
• Use a pillow when coughing: If your surgical wound hurts when you cough or sneeze, gently place a pillow over your stomach. This will help reduce the pain.
• Sleep well: Rest is essential for a speedy recovery.
• Get psychological support: Talking to someone who has gone through this type of surgery can be a great source of strength. Ask your doctor for advice about this.

Risks of surgery and when to see a doctor

Like any major surgery, cystectomy carries some risks. These include bleeding, infection, and damage to surrounding organs. There are also potential complications, such as urinary tract infections (UTIs), constipation or diarrhea, problems absorbing nutrients like vitamin B12, and changes in sexual function.