A radical cystectomy is a surgical procedure that is used to remove the complete bladder as well as portions of the urethra, nearby lymph nodes and also the surrounding organs that may have been affected with cancerous cells from the bladder.
This surgery is a last-resort, yet effective, treatment for an advanced case of bladder cancer as well as to treat a recurring bladder cancer that has returned after having been treated previously.
This surgery involves removing the prostrate, seminal vesicles as well as a part of the vas deferens in men, while in women this surgery involves removal of the uterus, cervix, fallopian tubes and part of the vagina that might have been affected by cancer.
Radical Cystectomy procedure
Radical cystectomy is usually considered as a treatment option if the bladder cancer is large in size or has spread to other parts of the bladder.
The surgery is nowadays performed using minimally invasive laparoscopic method. This method involves using thin and flexible surgical tubes (laparoscopes) to perform the surgery. This type of surgery requires less number (2-3) and smaller-sized (keyhole) incisions. The laparoscope, initially, has a light-source and a small, but powerful, video camera attached to its end. Other similar surgical tubes are attached with special miniaturized surgical instruments that are required during the surgery.
The surgery begins with the administering of general anesthesia in order to avoid any form of pain or discomfort to you during the surgery. The surgeon will then make very small (keyhole-sized) incisions in the abdomen to access the pelvic region.
The laparoscope with the video camera attached to its end is first inserted through one of the incisions. This allows the surgeon to get a clear and real-time detailed view of the bladder and its various parts, which helps the surgeon to determine the extent of organs and tissues around the bladder that will need to be removed in order to treat the slowly spreading cancer.
The surgeon will then use the tiny surgical instruments attached to the laparoscopes and remove the affected bladder along with the other surrounding parts that have also been affected.
After the cancer-affected tissues and organs are removed the surgeon will check for any other remaining cancerous cells that might cause the cancer to recur later. The surgeon will then simply use band-aids to cover the incisions and the incision holes get healed faster naturally due to their small size.
Post-radical Cystectomy reconstruction
If your bladder needs to be removed due to cancer then the surgeon will create other alternative ways for your urine to be stored as well as excreted out of the body. There are several types of reconstructive surgeries that can help restore the functions of the removed bladder, and its related organs, by alternative means. The type of reconstructive surgery best-suited for your individual case will depend mostly on your medical condition as well as your personal preference and the doctor’s/surgeon’s advice.
These are the few commonly performed reconstructive surgeries after a radical cystectomy procedure:
- Incontinent Diversion – This involves removing a piece of your intestine and using it to connect to the ureters. This helps to create a passageway (ileal conduit) for the urine to pass from the kidneys to the urethra and excreted out of the body. One end of this artificial passageway is attached to the front abdominal skin by an opening called a ‘stoma’, created using a procedure known as n ‘urostomy’.
The surgeon will next place a small bag over the stoma to collect the urine which is excreted by the body in small amounts continuously. This procedure is called as an ‘incontinent diversion’ as you are not able to control the flow of the urine from the body.
- Continent Diversion – Another alternate for urine draining is known as a ‘continent diversion’. In this, the surgeon will make a pouch from a piece of your intestine and attaches it to the ureters. The other end of the pouch is connected to the stoma (opening) in the front abdominal skin. The surgeon will create a valve in the pouch to allow urine to be stored there. A catheter can be simply inserted into the stoma in order to drain the urine being collected there. This is considered a better alternate than an ‘incontinent diversion’ as it does not require attaching an uncomfortable urine bag.
- Neobladder – This is a comparatively more modern alternate to restore the flow of urine after a complete (radical) cystectomy has been performed. The surgeon creates a new bladder using a piece of your intestine. This surgery also requires connecting the ureters to the neobladder. The only variation in this method is that the neobladder is also sewn to the urethra which allows the patient to urinate normally.
Risks associated with Radical Cystectomy
The risks associated with radical cystectomy procedure are similar to those seen in any major surgery, such as:
- Anesthetic reaction
- Blood clots
- Organ damage
Bladder surgery affects the way you urinate normally. in case of a radical cystectomy, you will require reconstructive surgery to create an alternate way for you to urinate as the surgery requires removing the bladder as well as the ureter. This alternate surgery (urostomy/urinary diversion) can also lead to certain rare risks such as:
- Urine leaks
- Urine blockage
- Pouch stones
Radical cystectomy is one of the last resorts to treat a severe case of bladder cancer that has spread from the bladder to the surrounding lymph nodes and other organs. The new minimally invasive surgical (laparoscopic) procedure is more advantageous than the conventional open-type of surgery as it allows for less pain, faster recovery and shorter hospital stay after the surgery.