Cystectomy: Shall we talk about this simply?

Have you or someone you know been told by your doctor that you need to have surgery to remove your bladder? It's normal to feel scared and anxious when you hear something like that. You probably have a lot of questions in your head about this surgery called a 'cystectomy'. You might be thinking things like, "Is this a big operation?", "Will I be able to live normally afterwards?" Don't worry. We'll talk about all of this in a very simple way that you can understand.

First of all, what is Cystectomy?

Simply put, a cystectomy is a surgical procedure to remove part or all of your bladder. The bladder is a sac-like organ that temporarily stores the urine produced in our body.

This is usually considered a major operation. The main reason doctors perform this operation is to treat bladder cancer. But not only that, but if the bladder is affected by other non-cancerous (benign) conditions, this operation can also be performed at that time. For example, it can be a solution to some congenital problems.

How to prepare for surgery?

Before this surgery, you will need to see a doctor. Your general health, fever, pulse rate, and blood pressure will be checked.

Also, the doctor will explain to you the nature of the surgery you are going to have. Because there are several ways to perform this surgery. The method that suits you best will be chosen based on your condition.

Important things to tell your doctor

• Tell your doctor about all the medications you are taking: Not just the ones prescribed by your doctor, but also over-the-counter (OTC) medicines, vitamins, and herbal remedies. Aspirin, some pain relievers, and blood thinners can increase bleeding during surgery. Do not stop taking any medications without asking your doctor.
• Tell us about your allergies: If you have any allergies to medications, latex, foods, and sometimes even iodine, which is used to clean the skin, let us know about them in advance.
• Food and Drink Instructions: Your doctor will give you instructions on what to eat and drink before surgery. Generally, it is best not to eat or drink anything after midnight the night before surgery. If you have to take any essential medication, you may be able to take it with a sip of water. Ask your doctor about that as well.

What happens during the surgery?

Your surgeon can perform this surgery in one of two ways. One is "open surgery," which involves making a larger incision in your abdomen. The other is "minimally invasive surgery," which involves making several smaller incisions and using a camera and robotic surgery.

Here are the steps that usually occur:

1. Anesthesia: First, you will be put under general anesthesia. This means that you will not feel anything until the surgery is over, and you will be completely asleep.

2. Incision: For open surgery, a vertical incision of about 6-7 inches will be made between your navel (belly button) and lower abdomen. For minimally invasive surgery, 5-6 small incisions of about one centimeter will be made in the abdomen.

3. Bladder removal: Depending on your condition, part or all of your bladder will be removed.

4. Creating a new way to pass urine: This is a very important step. Once the bladder is completely removed, a new way for the urine to pass from the kidneys to the outside of the body needs to be created. There are several methods for this. For example, `(Ileal conduit/urostomy)`, `(Indiana pouch)` or `(Neobladder)`. The surgeon will discuss with you in advance which method is best for you based on your medical history and needs.

5. Stitching the incision: Finally, the incisions are closed, stitched, and covered with bandages.

What are the benefits and risks of this surgery?

The main advantage of this surgery is that it can successfully treat serious conditions such as bladder cancer.

However, like any major surgery, there are some risks involved, and it's important to be aware of those as well.

• There may be excessive bleeding during or after surgery.
• There is a risk of blood clots .
• Infections can occur in cuts or wounds.
• Bowel complications are possible.
• Sometimes scar tissue can form and obstruct the flow of urine from the kidneys.
• Adverse reactions to anesthesia.
• Problems with wound healing.

These risks do not occur in everyone. Your medical team will do their best to minimize them.

What happens after the surgery?

After the surgery, you will be taken to a recovery room. There, the medical team will closely monitor your condition and give you medication to control any pain you may be experiencing.

During your recovery, you may experience loss of appetite, changes in bowel movements, and changes in urination.

• If part of your bladder was removed (partial cystectomy): Your bladder is now smaller than before, so you may need to urinate more often.
• If completely removed: You will have to urinate through the newly created system. That's how it works. It's also normal to have mucus-like substances in your urine at this time.

Can it affect sex life?

Sometimes this surgery can have some effects on your sex life. There may be problems with sexual arousal, and if part of the vagina is removed, intercourse may be difficult. Don't be shy about talking openly with your doctor about this. He or she can give you the necessary advice.

How long does it take to recover?

The length of time you will stay in the hospital depends on the type of surgery performed.

• If you had minimally invasive surgery , you will only have to stay in the hospital for about a day.
• If you had an open cystectomy , you may have to stay in the hospital for about a week.

During your stay in the hospital, doctors and nurses will monitor your well-being. If you need to use an ostomy bag, they will teach you how to fit, empty, and change it.

It may take several weeks or months to fully recover. During this time, you will need to see your doctor again (follow-up visits).

You will be able to go back to work and do light work in a few weeks, but you will need to wait at least six weeks before doing anything strenuous, such as heavy lifting or lifting weights.

When should you call the doctor?

Once you get home after surgery, it's important to take care of your body. If you experience any of the following symptoms, don't waste time and call your doctor right away.

It's normal to have a lot of thoughts and fears when you know you're going to have a major surgery like this. But you're not alone. Your doctors, nurses, and family will help you through this journey. Talk to them about any questions or fears you have. It can be a great relief.