What is a Radical Cystectomy?
A Radical Cystectomy is a procedure that involves the removal of the entire bladder.
- For men this procedure also involves the removal of the prostate and seminal vesicles.
- For women, radical cystectomy also often involves removal of the uterus, ovaries and part of the vagina. (Sexual organs can be spared if no compromise in cancer outcome can be achieved to improve functional outcomes. (urinary continence and sexual function)
After having your bladder removed, Dr Kim also needs to create a urinary diversion. This is required to store urine and have it leave your body.
There are multiple ways that urine can be stored and eliminated after bladder removal. Please see the urinary diversion page.
Why is Cystectomy Performed?
A Cystectomy is performed to treat:
- invasive or recurrent noninvasive high grade bladder cancer despite intravesical therapy
- invasive bladder cancer after chemoradiotherapy (known as Salvage cystectomy)
- other pelvic tumours as part of pelvic exenteration surgery (advanced colon, prostate or endometrial cancer)
- some non-cancerous (benign) conditions (severe radiation cystitis, interstitial cystitis or congenital abnormalities.)
Types of Radical Cystectomy
There are three common approaches to Radical Cystectomy these are:
- Open surgery
- Minimally invasive laparoscopic surgery
- Robotic surgery
Preparation Before a Radical Cystectomy
In order to prepare for the surgery, the patient should be adequately counselled to ensure that the informed consent obtained is fully understood.
Dr Kim and his dedicated team then runs a number of tests to ensure that the patient is fit and in good health for the surgery. These will include:
- a thorough physical examination.
- Pathology Tests,
- Urine Analysis,
- Scans if needed, and
- Consultations with any relevant specialty colleagues
Prior to surgery you are advised not to eat anything for six hours before the procedure. Patients are also encouraged to increase carbohydrate intake as part of enhanced recovery protocols.
During a Radical Cystectomy
The steps in radical Cystectomy vary a little depending on the approach taken for the incision.
During cystectomy, Dr Kim removes the bladder and part of the urethra, along with pelvic lymph nodes. He also creates a new route for urine to leave your body.
The anaesthesia will also vary between general and regional sedation, depending upon the technique used and point of incision.
- Open surgery. This approach requires a single incision on your abdomen to access the pelvis and bladder.
- Minimally invasive Laparoscopic surgery. Dr Kim makes several small incisions on your abdomen where special surgical tools are inserted to access the abdominal cavity.
- Robotic surgery. During this type of minimally invasive surgery, Dr Kim will make multiple small incisions to allow robotic instruments and sits at a console and remotely operates the fine robotic surgical tools.
Recovery After a Radical Cystectomy
The patient is kept in the recovery room for observation and their vitals are monitored. Pain medication is administered as needed via IV lines. The patient is moved to a ward or Intensive care unit in a few hours, and can often begin to take clear liquids.
Dr Kim and his team will ensure that all the post operative measures are undertaken to minimise risk of potential complications. This would mean that you will be offered regular pain relief, blood thinners, elastic compression stockings and calf compressors for prevention of blood clots (DVT or PE), physiotherapist, and stoma nurse specialist. Pain medication can also be taken on an as per need basis. Your diet will be gradually escalated as deemed appropriate based on your recovery as per the enhanced recovery pathway. Your stents will be removed normally around 10 days after surgery but can vary depending on your recovery, nature of surgery (primary or salvage cystectomy), and type of urinary diversion. Dr Kim and his team will also provide specific instruction for wound care including bathing.
Until notified, driving is discouraged unless cleared by Dr Kim’s team, along with some other activities.
Care Plan After a Radical Cystectomy
Dr Kim will devise a care plan for the patient for the next few months, to aid in recovery and to help improve bladder control in case of neobladder formation. You will be provided a low dose of blood thinners for up to 4 weeks after surgery to avoid risk of blood clots in the legs or lungs (DVT/PE), which is one of the biggest life threatening events after radical cystectomy.
Dr Kim will also advise a follow-up visit chart to check the patient’s progress in the clinic as well and to check for any post-surgical complications.
Risks and Complications of a Radical Cystectomy
Cystectomy is a complex surgery, involving the manipulation of many internal organs in your abdomen. Because of this, cystectomy carries with it certain risks, including:
- Anaesthetic risks (ie cardiovascular and respiratory complications)
- Injury to surrounding structures
- Ileus (prolonged time for bowels to return to normal function)
- Blood clots
Since cystectomy is a surgery not just to remove the bladder but also to create a urinary diversion, the surgery includes additional risks, such as:
- Electrolyte abnormalities
- Urinary tract infection
- Leak from the bowel anastomosis or ureteroileal (ureter to conduit or neobladder) anastomosis
- A blockage that keeps food or liquid from passing through your intestines (bowel obstruction)
- A blockage in one of the tubes that carries urine from the kidneys (ureter blockage)
Some complications may be life-threatening. You may need to go back to the operating room for surgery to fix the complication, or you may need to be readmitted to the hospital. Ask Dr Kim what additional risks there may be for your particular surgery.