Laparoscopic Cystoprostatectomy

Laparoscopic Cystoprostatectomy is a minimally invasive surgical procedure involving the removal of the urinary bladder (cystectomy) and the prostate gland (prostatectomy). It is commonly performed for the treatment of advanced bladder cancer or other conditions affecting both the bladder and prostate. This laparoscopic approach offers the benefits of smaller incisions, reduced pain, and faster recovery compared to open surgery.

Indications

The procedure is typically indicated for:

1. Bladder Cancer:
   • Muscle-invasive bladder cancer (MIBC).
   • Non-invasive bladder cancer that is recurrent or unresponsive to conservative treatments.
2. Prostate Cancer with Bladder Involvement:
   • Locally advanced disease requiring removal of both organs.
3. Chronic, Severe Bladder and Prostate Disorders:
   • Refractory bladder dysfunction with associated prostatic conditions.

Preoperative Preparation

1. Diagnostic Workup:

   • Imaging studies such as CT, MRI, or PET scans to assess the extent of the disease.
   • Cystoscopy to evaluate the bladder’s interior.
   • Biopsy to confirm cancer diagnosis.
   • Blood tests, including PSA levels, kidney function tests, and tumor markers.

2. Patient Counseling:

   • Discussion about the goals of the surgery, possible complications, and life after surgery (including urinary diversion options).

3. Urinary Diversion Planning:

   • Options include ileal conduit, continent reservoir, or neobladder reconstruction based on patient preference and suitability.

4. Anesthesia and Fasting:

   • General anesthesia is used. Patients are instructed to fast preoperatively.

Procedure Overview

1. Positioning:

   • The patient is placed in a Trendelenburg position (head-down tilt) for optimal access to the pelvis.

2. Trocar Placement:

   • Multiple small incisions (5-6) are made for laparoscopic ports, including a camera port for visualization.

3. Cystoprostatectomy:

   • The bladder and prostate are carefully dissected using laparoscopic instruments.
   • Surrounding lymph nodes are removed (lymphadenectomy) to check for metastasis.
   • Ureters are detached from the bladder and preserved for urinary diversion.

4. Urinary Diversion:

   • After organ removal, the urinary flow is rerouted using one of the following:
     • Ileal conduit: A small piece of intestine is used to create an external stoma for urine drainage.
     • Continent reservoir: An internal pouch is constructed for urine storage.
     • Neobladder: A new bladder is formed from intestinal tissue, connected to the urethra for natural voiding.

5. Specimen Retrieval:

   • The bladder, prostate, and lymph nodes are removed through an extended port incision or specimen retrieval bag.

6. Closure:

   • Incisions are sutured, and drainage tubes may be placed to prevent fluid buildup.