Radical Cystectomy

Radical Cystectomy is a surgical procedure that involves the removal of the bladder along with surrounding tissues and organs, typically to treat advanced bladder cancer. It is often combined with urinary reconstruction to divert urine flow after bladder removal.

Indications

Radical cystectomy is performed for:

1. Muscle-Invasive Bladder Cancer (MIBC):
   • Cancer that has invaded the muscular layer of the bladder wall.
2. High-Risk Non-Muscle-Invasive Bladder Cancer (NMIBC):
   • Cancer that recurs or does not respond to intravesical therapy (e.g., BCG).
3. Advanced or Refractory Bladder Cancer:
   • Cases where other treatments have failed.
4. Other Indications:
   • Rare bladder diseases like severe interstitial cystitis or bladder damage.

Types of Radical Cystectomy

1. Male Patients:
   • Removal of the bladder, prostate, seminal vesicles, and surrounding lymph nodes.
2. Female Patients:
   • Removal of the bladder, uterus, ovaries, fallopian tubes, part of the vaginal wall, and lymph nodes.
3. Partial Cystectomy:
   • Only a portion of the bladder is removed (less common).

Preoperative Preparation

1. Diagnostic Workup:

   • Cystoscopy: To assess the bladder.
   • CT/MRI/Ultrasound: Imaging to evaluate tumor extent and metastasis.
   • Urinalysis and Urine Cytology: To detect infection and cancer cells.
   • Blood Tests: To check overall health.
   • Pulmonary and Cardiac Evaluation: For anesthesia fitness.

2. Patient Counseling:

   • Explain the procedure, risks, and urinary diversion options.
   • Discuss lifestyle changes after bladder removal.

3. Bowel Preparation:

   • May be required for some urinary diversion techniques.

4. Smoking Cessation:

   • Strongly encouraged to reduce complications and improve healing.

5. Prophylactic Antibiotics:

   • Administered to prevent infections.

Surgical Procedure

Radical cystectomy can be performed using:

1. Open Surgery:
   • Traditional approach with an abdominal incision.
2. Laparoscopic Surgery:
   • Minimally invasive using small incisions and specialized instruments.
3. Robot-Assisted Surgery:
   • Provides enhanced precision and faster recovery.

Steps of the Procedure:

1. Bladder Removal:
   • The bladder and surrounding structures (prostate in males, reproductive organs in females) are excised.
2. Lymph Node Dissection:
   • Removal of nearby lymph nodes to check for cancer spread.
3. Urinary Diversion:
   • Reconstructing the urinary system using one of the following methods:
     • Ileal Conduit: Urine flows from the kidneys to a segment of the small intestine, exiting through a stoma on the abdomen.
     • Neobladder: A new bladder is created from a piece of intestine, allowing urination through the urethra.
     • Continent Cutaneous Reservoir: A pouch is formed inside the abdomen, and urine is drained via catheterization.

Postoperative Care

1. Hospital Stay:

   • Typically 7-10 days, depending on recovery and complications.

2. Pain Management:

   • Administer analgesics and regional anesthesia as needed.

3. Urinary Diversion Management:

   • Educate on stoma care or catheterization for continent reservoirs.

4. Nutritional Support:

   • Gradual reintroduction of food and fluids.

5. Activity Restrictions:

   • Avoid heavy lifting and strenuous activities for 6-8 weeks.

Follow-Up Care

1. Wound Care:
   • Monitor for signs of infection or dehiscence.
2. Cancer Surveillance:
   • Regular imaging and laboratory tests to detect recurrence.
3. Urinary Function Assessment:
   • Evaluate the effectiveness of urinary diversion.
4. Lifestyle Support:
   • Counseling for psychological adjustment and dietary modifications.

Benefits

• Effective treatment for advanced bladder cancer.
• Reduces the risk of cancer recurrence.
• Offers potential for long-term survival and quality of life improvement.