51585 Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

Name of the Procedure:

Complete Cystectomy with Ureterosigmoidostomy or Ureterocutaneous Transplantations; Bilateral Pelvic Lymphadenectomy (including External Iliac, Hypogastric, and Obturator Nodes)

Summary

A complete cystectomy involves the surgical removal of the entire bladder. This procedure often includes ureterosigmoidostomy or ureterocutaneous transplantations to reroute urine flow since the bladder is no longer present. Additionally, the procedure entails bilateral pelvic lymphadenectomy, which means removing lymph nodes from both sides of the pelvis to check for cancer spread.

Purpose

This procedure is primarily performed to treat bladder cancer, particularly invasive or high-grade cancers that have not responded to other treatments. It aims to remove the cancerous tissues and prevent the spread of cancer to other body parts. The lymph node removal helps in staging the cancer and determining the appropriate post-operative treatments needed.

Indications

• Invasive bladder cancer
• High-grade bladder tumors
• Recurrent bladder cancer
• Bladder damage or severe dysfunction causing life-threatening complications

Preparation

• Fasting several hours before surgery
• Adjustments to current medications as directed by the healthcare team
• Pre-operative tests such as blood work, imaging studies (CT, MRI), and cardiac evaluations
• Bowel preparation may be required

Procedure Description

1. Anesthesia: General anesthesia is administered for the procedure.
2. Incision: A surgical incision is made in the lower abdomen.
3. Bladder Removal: The bladder is carefully detached from the surrounding tissues and removed.
4. Urinary Diversion: Ureterosigmoidostomy or ureterocutaneous transplantation is performed to create an alternative pathway for urine.
   • Ureterosigmoidostomy: The ureters are connected to the sigmoid colon.
   • Ureterocutaneous Transplant: The ureters are brought out to the skin, creating a stoma.
5. Lymphadenectomy: Lymph nodes from the external iliac, hypogastric, and obturator regions are removed for pathological examination.
6. Closure: The surgical incisions are closed with sutures or staples.

Duration

The procedure typically takes 4-6 hours, but the duration can vary depending on the complexity of the surgery and the patient's condition.

Setting

The procedure is performed in a hospital surgical suite equipped with specialized tools and equipment.

Personnel

• Surgeon specializing in urology or oncology
• Surgical nurses
• Anesthesiologist
• Surgical assistants
• Pathologist (for evaluating the lymph nodes)

Risks and Complications

• Infection at the surgical site
• Bleeding or blood clots
• Urinary tract infections
• Anesthetic complications
• Bowel or ureteral injuries
• Electrolyte imbalances (especially with ureterosigmoidostomy)
• Postoperative hernia
• Organ dysfunction

Benefits

• Removal of cancerous tissues and potential cure of bladder cancer
• Prevention of cancer spread
• Improved quality of life if cancer is causing significant discomfort or invasive issues
• Enhanced survival rates for invasive bladder cancer patients

Recovery

• Hospital stay of 1-2 weeks post-surgery
• Pain management with medications
• Gradual reintroduction to solid foods after bowel function returns
• Instructions on stoma care (if ureterocutaneous transplant is performed)
• Follow-up appointments to monitor recovery and manage any complications
• Restrictions on heavy lifting and strenuous activities for several weeks
• Potential for temporary or permanent changes in urinary habits

Alternatives

• Partial cystectomy (removal of part of the bladder)
• Radiation therapy
• Chemotherapy
• Immunotherapy
• Active surveillance for small, non-invasive tumors
• Pros and cons vary; less invasive options may not be as effective for advanced cancers but carry fewer immediate risks.

Patient Experience

• Patients may experience pain and discomfort immediately following the surgery, managed with prescribed pain relief.
• The adjustment period for new urinary diversion methods can be challenging.
• Long-term adaptation to stoma care if ureterocutaneous transplant is performed.
• Emotional and psychological support may be beneficial due to the impact on lifestyle and body image.

Pain and discomfort will typically decrease over time as recovery progresses, and most patients will adapt to their new urinary systems with proper guidance and support.