Introduction
Healthcare is a field that constantly evolves, offering innovative solutions to enhance the lives of individuals facing complex medical challenges; in the world of urology, the treatment of bladder cancer, especially muscle-invasive bladder cancer, poses unique challenges when it comes to female patients. Radical cystectomy and urinary diversion have emerged as significant procedures, particularly for women. These procedures, which involve the removal of the bladder and the rerouting of urine flow, represent a cornerstone in urological care, providing improved quality of life. This article digs into the complexities and considerations surrounding radical cystectomy and urinary diversion options for women.
What Are Treatment Modalities and Gender Disparities for Radical Cystectomy and Urinary Diversion?
For bladder cancers, the standard treatment is radical cystectomy along with pelvic lymph node dissection and neoadjuvant cisplatin-based chemotherapy, if possible. However, only 27 percent of these patients receive radical cystectomy. In women, radical cystectomy historically includes the surgical removal of the bladder, complete urethra, anterior vaginal wall, uterus, and ovaries. The necessity of removing the complete urethra has been questioned, as various studies have shown that urethral recurrence is rare and preserving it does not compromise oncological safety.
What Is a Radical Cystectomy?
A radical cystectomy is a surgery done to remove the bladder to prevent the spread of cancer. It may also be accomplished by removing regional lymph nodes and some part or complete urethra. As doctors can detect the level the cancer has spread, specific organs may also be removed. The procedure can be performed on both males and females. In males, organs located near the bladder that is also removed include the prostate and the seminal vesicles. A radical cystectomy may also remove a woman's uterus, ovaries, and fallopian tubes. In some patients, parts of the vagina may also be removed.
Before any radical surgery, the doctor recommended CT (computed tomography) scans or an MRI (magnetic resonance imaging) in order to understand the possibility of metastatic or "distant" disease in other parts and organs of the body. If the patient has a metastatic condition, surgery to remove the bladder is not advised, and the patient will be asked to get an appointment with a healthcare professional dealing with oncology for further treatment. A radical cystectomy also creates a urinary diversion as the bladder is removed in the procedure.
What Are the Alternatives for Radical Cystectomy?
The following are some other alternatives to a radical cystectomy.
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In a radical cystectomy, only a part of the bladder is removed.
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Radiotherapy.
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A combination of radiotherapy and chemotherapy.
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Bladder preservation.
What Are the Types of Urinary Reconstructions Recommended After Bladder Removal?
Ileal Conduit:
In women undergoing radical cystectomy and urinary diversion, an ileal conduit may be used as a form of urinary diversion. After the removal of the bladder, a small segment of the small intestine (ileum) is isolated and detached from the digestive system. One end of the ileum is connected to the ureters, which carry urine from the kidneys, while the other end is brought out through the abdominal wall to create a stoma. A urostomy bag is attached to the stoma to collect and contain urine.
The ileal conduit serves as a new pathway for urine to exit the body since the natural bladder is no longer present. This type of urinary diversion allows for continence and maintains the flow of urine from the kidneys. It requires ongoing stoma care and the regular emptying and replacement of the urostomy bag. The choice to use an ileal conduit in radical cystectomy and urinary diversion depends on various factors, including the individual's medical condition, preferences, and the surgeon's expertise. It is important for women undergoing this procedure to receive comprehensive pre-operative counseling and post-operative support to adapt to the changes in urinary function and manage the stoma effectively.
Continent Cutaneous Pouch (CCP):
An internal storage "container" for urine. Using a combination of small and large intestines, the healthcare professional will reconstruct the tubular shape of the intestine and create a pouch. This pouch is attached to the skin on the abdomen by a small stoma forming a kind of continent urinary reservoir; no external bag is required. The patient drains the pouch from time to time by inserting a catheter through that small stoma and then removing the catheter. Sometimes patients can cover the stoma with a bandage.
Neobladder:
A neobladder is a type of internal reservoir for storing urine. Using a portion of the small intestine, the doctor will reconstruct the tubular shape of the intestine and create a sphere. By tensing the abdominal muscles and relaxing specific pelvic muscles, the patient can push the urine through the urethra. The doctor then connects the pouch to the urethra, forming a neobladder, in which case the patient can usually pass urine out of the body.
How to Support the Quality of Life after Radical Cystectomy and Urinary Diversion in Women?
After radical cystectomy surgery, patients can expect support from their health care team, including nurses who can teach the patient how to care for their stoma and change their urine collection pouch if necessary. Follow-up appointments and home visits may be arranged to ensure proper care and recovery.
In addition, sexual health and quality of life are important considerations when planning treatment. Surgeons specializing in bladder cancer are committed to preserving sexual function and providing support to manage side effects.
However, addressing gender disparities in radical cystectomy treatment and ensuring that female patients receive equal oncological outcomes and urinary diversion options as male patients. Proper counseling, informed decision-making, and the use of advanced surgical techniques can help improve women's outcomes and quality of life following bladder cancer treatment.
Conclusion
In conclusion, radical cystectomy with urinary diversion is a significant surgical procedure performed in women with advanced bladder cancer or other conditions necessitating bladder removal. It involves the removal of the bladder and the creation of a urinary diversion to redirect urine flow. The choice of urinary diversion depends on individual factors. While the surgery carries risks and requires a recovery period, it can effectively remove cancerous tissue and improve long-term survival rates. Comprehensive counseling, post-operative support, and rehabilitation are crucial for helping women adapt to the changes in urinary function and enhance their overall quality of life.
