is an X-ray of a patient who underwent
a cystectomy (removal of the bladder)
followed by the creation of a new
bladder. This is a specialized operation
which is now available in Cambridge
is Total Cystectomy?
is surgical removal of all or part of the
urinary bladder. Total Cystectomy, also
known as Radical Cystectomy is surgical
is the removal of the entire bladder, nearby
lymph nodes (lymphadenectomy), part of the
urethra, and nearby organs that may have
been invaded by the cancer cells. In men,
the nearby organs that are removed are the
prostate, the seminal vesicles, and part
of the vas deferens. In women, the cervix,
the uterus, the ovaries, the fallopian tubes,
and part of the vagina are also removed.
The ureters are disconnected from the bladder
and urinary diversion is created.
What is Partial
or Segmental Cystectomy?
Cystectomy or Segmental Cystectomy is removal
of part or segment of the bladder and is
usually performed for the resection of stage
I and II bladder cancer.
to remember -
- In this procedure the urinary bladder
and pelvic lymph nodes are removed along
with distal parts of ureters, seminal
vesicles, vas deferens and part of the
Anterior Pelvic Exteneration - In this
procedure the urinary bladder, pelvic
lymph node, ureters, cervix, part of
urethra, uterus, fallopian tubes, ovaries
and part of the vagina are removed.
Bladder Reconstruction / Urinary Diversion
- Two techniques are usually used to
divert the urine after Total Cystectomy:
Continent Cutaneous Urinary Diversion
(CCUD) - A reservoir is created
internally from a piece (15 - 20
cm) of your bowel which is attached
on one end to the ureters and on
the other end to the urethra. This
is a method used to internally substitute
your bladder and may allow you to
urinate as before. In some cases
it may require you to apply pressure
on your abdomen or insert catheter
to urinate. If part or all of your
urethra was removed during Total
Cystectomy, then the reservoir opens
through a urostomy on your abdomen
which needs to be catheterized to
release the urine several times
a day and during the night.
Incontinent Cutaneous Urinary Diversion
(ICUD) - In this technique, an ileal
conduit or channel is created using
a piece of your small intestine
that connects your ureters to a
urostomy opening on your abdomen.
The urine passes from the ureters
through the conduit and out the
urostomy into a plastic bag which
is attached to your skin.
Who is an ideal candidate for Total
you have bladder cancer that has invaded
the muscle layer and is locally invasive
or if your cancer has come back after the
initial treatment, then you are an ideal
candidate for Total Cystectomy.
do I prepare for Total Cystectomy?
surgical team will provide you with instructions
about the care of the urostomy opening and
the bag. Routine blood and urine analysis,
CT of abdomen and chest x-ray will be requested
by your physician on your pre-oparative
consult. Inform your physician about your
other health conditions and medications
(including all the prescription, non-prescription
medications, nutritional supplements i.e.
vitamins, minerals and herbal products).
Refrain from taking aspirin or Ibuprofen
at least 2 weeks before Total Cystectomy.
Stop smoking a few weeks before Total Cystectomy
to prevent healing problems during recovery
period. Do not eat or drink anything for
at least 10 hours before the Total Cystectomy
surgery. You will be instructed to be hospitalized
the night before the surgery. You may be
given an enema the night before to cleanse
does the procedure for Total Cystectomy
Cystectomy is performed under general anesthesia
and may take about 2 - 3 hours. An incision
is made across the lower abdomen, the ureters
are cut from the bladder, freeing it for
removal. The bladder and associated organs
i.e. prostate gland, seminal vesicles, vas
deferens in men and the uterus, fallopian
tubes, ovaries, and part of the vagina in
women. A method of urinary diversion is
created to remove the urine (as discussed
above) after Total Cystectomy. The tissues
and nerves around the prostate and bladder
are dissected very carefully to ensure not
to damage them (nerve sparing technique)
during Total Cystectomy procedure. However,
the nerves controlling erection of penis
may be damaged during the surgery. In women,
your surgeon will reconstruct your vagina
after Total Cystectomy.
is the recovery period like following Total
Cystectomy entails surgery to the bladder
as well as the bowel. You will spend the
next couple of days in the Intensive Care
Unit (ICU) under observation following Total
Cystectomy. Your vital signs, circulation
and respiration will be closely monitored.
You will also be closely monitored for any
immediate post-operative complications like
excessive bleeding. There may be a stoma
bag collecting urine that will need to be
cared for. You will notice thin tubes coming
out of the urostomy. These are called stents.
They will be removed 7-10 days after your
Total Cystectomy operation. There will also
be a small plastic drain tube from your
abdomen that will stay in place for about
5-7 days. You will experience some pain
and discomfort which can be alleviated by
the use of pain medication. Keep the operation
area clean, avoid heavy lifting and sexual
activity for 3 - 4 weeks. You will be able
to get back to your normal activities in
2 months time following Total Cystectomy.
You will probably be hospitalized for 8
- 10 days after Total Cystectomy procedure.
Before going home you will be provided with
a follow up regimen that will comprise of
Cystoscopy and urinary exams every 3 months
for at least 2 years, with regular CT scans
of the pelvis and abdomen.
is the outcome of Total Cystectomy?
5 year survival rate for people who have
bladder cancer is 75%. Adjuvant therapy
may be needed following a Total Cystectomy
which may include radiation therapy, chemotherapy
or biological therapy (immunotherapy).
B . R . A
. N . D . of Total Cystectomy
of Total Cystectomy
5 year survival rate after Total Cystectomy,
for people who have bladder cancer is 75%.
of Total Cystectomy
Perforation of bowel with peritonitis
Injury to urethra and / or rectum
Alternatives to Total Cystectomy
or Segmental Cystectomy
Now or Never
improvements in surgical technique and instruments,
the evolution of intensive care medicine,
and the availability of new antibiotics,
Total Cystectomy now is a relatively common
procedure in most major medical centers.
to have Total Cystectomy
the advent of advanced techniques and equipment,
surgical resection of bladder tumour via
Total Cystectomy remains standard treatment
for optimizing curative potential and minimizing
the risk of recurrence.
to "Urology Surgery"