Radical Cystectomy for Bladder Cancer: Risks, Benefits, and Recovery

What Is Radical Cystectomy?

Suppose you are confirmed with the diagnosis of bladder cancer that fails to respond to the traditional forms of bladder cancer treatments. In that case, your physician may suggest radical cystectomy (bladder removal surgery), which involves the complete removal of the bladder.

The procedure comprises two steps - radical cystectomy (RC) and urinary diversion. In radical cystectomy, your doctor will completely remove the bladder along with nearby lymph nodes. This helps to prevent the spread of cancer. While performing this procedure, the male reproductive structures, like the vas deferens and prostate, are removed. Certain organs that play a vital role in reproduction are removed in females.

Since the bladder is no longer present, the second stage is to create a way to store and eliminate the urine from our body. This could mean developing an opening in your abdomen called a stoma. Sometimes, a new bladder is created using the intestine, which is known as a neobladder. The radical cystectomy procedure is the gold-standard treatment for managing advanced bladder cancers. It is always combined with chemotherapy and lymph node removal. Less invasive techniques are now available due to recent advances in treatment procedures. These procedures provide a quicker recovery, but their long-term effectiveness is still being studied.

Who Needs a Radical Cystectomy?

A radical cystectomy is advised when you do not notice any improvement with other forms of treatment.

Here is when the doctor will advise you on this treatment -

• Cancer that has spread to the muscular layer of the bladder.

• If you are diagnosed with colon or prostate cancer, this procedure is performed to avoid metastasis.

• Radical cystectomy is indicated when you are suffering from interstitial cystitis. The surgery is done only when all other traditional treatments have failed to treat it.

• Any developmental defect in the bladder might require cystectomy.

• Certain cases of transitional cell carcinoma of the bladder require radical cystectomy. It is more common in individuals with a bladder diverticulum, a condition in which there is a bulge in the bladder wall that resembles a pouch. Cancer or infection is common in the pouch.

• The existence of a fistula that connects the colon and the bladder necessitates a cystectomy.

What Happens Before the Surgery?

An appointment with your doctor before the surgery generally involves discussing your overall health and the process involved in the surgery.

Here are a few things that typically happen before the procedure -

• Your doctor checks vital signs to avoid any last-minute complications.

• Your doctor will explain whether you will undergo partial or radical cystectomy.

• Your doctor will evaluate your complete medical history.

• Also, inform your doctor about your current medications, including over-the-counter medicines, herbal supplements, Aspirin, or any other blood thinners, because this may increase your risk of bleeding during surgery.

• Inform your doctor if you are allergic to latex, iodine, or other medications.

This appointment is to ask questions, clarify doubts, and feel confident about the procedure. The better prepared you are, the easier everything will be.

What Happens During the Procedure?

You know what? You are not alone while undergoing the cystectomy procedure. You can expect a team of doctors around you. The team includes a urologist, an anesthesiologist, and nurses.

So, how is the radical cystectomy procedure done step-by-step? The initial step is to administer general anesthesia, which makes you not feel pain, and you will fall asleep. Then, the urologist will perform the surgery using one of two techniques.

• Open Cystectomy: In this method, your surgeon will make a long vertical incision between your belly button and pelvic bone to remove the bladder. This is the traditional method. Due to longer incisions, it would take a long time to heal.

• Minimally Invasive Surgery: In this approach, your surgeon will make four to five small incisions instead of one big incision. Your surgeon will insert small tools through the incision to work on your bladder. This is called laparoscopic surgery.

• Robotic Surgery: During this procedure, your surgeon controls robotic tools to perform the surgery. The tools provide a clear vision and precise movements.

What Are the Types of Urinary Diversion After Surgery?

Even if your bladder is removed, you will need something to store and eliminate the urine from your body. Urinary diversion surgery is the solution for that!

Surgeons develop a unique way for urine to exit the body, with three major choices to consider:

• Ileal Conduit: Consider this a simple urine-rerouting mechanism. Your surgeon connects a small part of your small intestine (known as the ileum) to your ureters, which are the tubes that deliver urine from the kidneys. The other end of the ileum exits your abdomen through a stoma and is connected to a bag to collect the urine.

• Continuous Cutaneous Diversion: This is an improvised version of the ileal conduit. This method creates a small pouch using a larger portion of the intestine to collect and store urine. It is connected to the ureters and then to the stoma. Instead of connecting directly to the bag through the stoma, you can empty the pouch a few times a day using a catheter.

• Neobladder: This is a more natural method than any other. In this, your doctor uses a portion of the intestine to create a new bladder and connect it to the urethra. Urine flows as before without needing a stoma, bag, or catheter. It may take some time to get control of this, but most people will get adjusted to it. This may not suit everyone, so check with your doctor to see if it is right for you.

What Happens After the Procedure?

Here is what happens after the surgery.

• Your surgeon closes the cut on your abdomen using sutures. It is then covered with protective bandages.

• The anesthesiologist will stop anesthetic medicine, and you will regain consciousness in some time.

• You will be moved to a recovery room. You will be constantly monitored for your vital signs.

• Is radical cystectomy painful? Oh yes, it is! A pain management specialist will help you manage pain with the help of medications or other strategies for pain relief.

How Long Does Recovery Take?

Bladder cystectomy recovery is not the same for all. It varies based on the type of surgery you have undergone and your overall health. It generally takes a few weeks or months to recover after surgery. If you have undergone partial cystectomy, your recovery period is less than that of those who have undergone radical cystectomy. In case of partial cystectomy, you will have to urinate often since the size of your bladder is reduced. In contrast, in radical cystectomy, you will have to adapt to using the external bag to eliminate urine.

What Are the Complications of Radical Cystectomy?

Radical cystectomy complications are:

• A few may report blood clotting.

• Infection is a common side effect reported by many individuals.

• A few may go through some damage to the nearby structures.

• You may get anesthesia-related complications.

• Men may experience erectile dysfunction after the surgery.

• Women may have difficulty with arousal due to nerve damage.

Conclusion:

Radical cystectomy is a procedure that helps treat bladder cancer. You will require a few months for recovery after surgery. If you notice any complications like bleeding, abnormal pain, nausea or vomiting, or any changes in your stoma during your recovery period, report to your doctor immediately. Your doctor will find the cause and help treat it to avoid further progression.

Keynote from iCliniq:

The process of complete removal of the bladder may be frightening, but you can overcome this with suitable support. The surgery is carried out by doctors from various specialties, including anesthesiologists, urologists, and nurses. Since it is a major surgery, you will require more time to heal after the surgery. If you have any concerns after the surgery, you can contact iCliniq doctors for expert advice.