Cystectomy is a surgical procedure that involves the removal of all or part of the urinary bladder. The bladder stores urine before it exits the body through the urethra. The cystectomy is typically performed for bladder cancer, but can also be performed for other bladder and urinary system disorders.
The most common reason for cystectomy is bladder cancer, a type of cancer that begins in the cells that line the inside of the bladder. It is possible for bladder cancer to invade the bladder's muscle tissue or spread to other parts of the body. In cases in which other treatments don't work or cause severe side effects, cystectomy may be recommended.
Other possible causes of cystectomy include:
Congenital abnormalities of the urinary system, such as bladder exstrophy, which is a condition where the bladder is exposed outside the body.
Neurological disorders that affect the bladder function, such as spinal cord injury, multiple sclerosis, or spina bifida.
Inflammatory disorders that damage the bladder, such as interstitial cystitis, which is a chronic condition that causes pain and inflammation in the bladder wall.
Urinary fistula, which is an abnormal connection between the bladder and another organ, such as the vagina, the rectum, or the skin.
Cystectomy is not a symptom, but a treatment for certain conditions that cause symptoms related to the bladder and the urinary system. Some of the symptoms that may indicate the need for cystectomy are:
Blood in the urine, which may be visible or detected by a urine test.
Difficulty or pain while urinating, or a frequent or urgent need to urinate.
Lower back pain or pelvic pain, which may be caused by the pressure of the tumor or the infection in the bladder.
Weight loss, loss of appetite, fatigue, or weakness, which may be signs of advanced cancer or infection.
Swelling of the feet or legs, which may be caused by the blockage of the lymphatic system or the veins by the tumor or the infection.
Before performing a cystectomy, the doctor will conduct a thorough evaluation of the patient's condition and medical history. The diagnosis of the underlying cause of cystectomy may involve several tests and procedures, such as:
Cystoscopy, which is a procedure that uses a thin, flexible tube with a camera and a light (cystoscope) to examine the inside of the bladder and the urethra. The doctor may also take a tissue sample (biopsy) from the bladder for further analysis.
Urine cytology, which is a test that examines the urine under a microscope to look for abnormal or cancerous cells.
Urogram, which is a type of X-ray that uses a contrast dye to show the structure and function of the kidneys, the ureters, and the bladder.
Retrograde pyelogram, which is a procedure that injects a contrast dye into the ureters through the cystoscope to obtain a clearer image of the bladder, the ureters, and the kidneys.
Other imaging tests, such as ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or positron emission tomography (PET) scan, which can provide detailed information about the size, location, and extent of the tumor or the infection.
The treatment of cystectomy depends on the type and extent of the surgery, as well as the patient's overall health and preferences. There are two main types of cystectomy:
Cystectomy partial is a procedure where only the tumor or infection is removed from the bladder. Patients with this type of surgery must have a small, localized, and non-invasive cancer or a benign bladder condition that only affects a limited area. After the remaining bladder is repaired and reconnected to the urethra, the patient can urinate normally again.
As part of a radical cystectomy, the entire bladder and surrounding structures are removed. This generally involves the removal of the prostate and seminal vesicles, which are glands responsible for producing semen. A woman's uterus, ovaries, fallopian tubes, and part of her vagina are usually removed. For patients with large, invasive, or recurrent bladder cancer, or severe bladder conditions, this type of surgery is recommended. Urinary diversion occurs after the bladder is removed, so urine will no longer leave the body through the bladder.
There are different types of urinary diversion, such as:
This procedure uses a segment of the small intestine (ileum) to create a tube connecting the ureters to an opening in the abdomen (stoma). The urine drains into a bag (urostomy pouch) attached to the stoma.
With a continence urinary reservoir, a segment of the small or large intestine is used to create a pouch in the body that stores urine. The pouch is connected to the ureters and to a stoma in the abdomen. By inserting a catheter through the stoma several times a day, the patient can empty the pouch.
An orthotopic neobladder is a procedure in which a segment of the small or large intestine is used to create a new bladder that connects to the urethra. By contracting the abdominal muscles, the patient can urinate through the urethra, but a catheter may be necessary to empty the bladder completely.
Prior to surgery, the surgeon will discuss with the patient the advantages and disadvantages of each type of urinary diversion.
While cystectomy is not a preventable procedure, some conditions that may require cystectomy can be prevented or reduced with a healthy lifestyle and regular screenings.
Avoiding smoking, which is the most important risk factor for bladder cancer and other urinary problems.
Drinking plenty of fluids, especially water, which can help flush out the harmful chemicals that may accumulate in the bladder.
Eating a balanced diet that is rich in fruits, vegetables, whole grains, and lean proteins, which can provide antioxidants and other nutrients that can protect the bladder and the urinary system.
Limiting the exposure to chemicals, radiation, or infections that may damage the bladder or the urinary system, such as industrial solvents, arsenic, cyclophosphamide, or schistosomiasis.
Based on the patient's age, gender, and risk factors, bladder cancer screening may include urine tests, cystoscopy, or imaging tests. It is possible to improve survival and reduce the need for cystectomy by detecting and treating bladder cancer early.
