Name of the Procedure:

Cystectomy, partial; complicated (e.g., postradiation, previous surgery, difficult location)

Summary

A partial cystectomy is a surgical procedure in which a portion of the urinary bladder is removed. When labeled as "complicated," this suggests that the surgery is more challenging due to factors such as prior radiation therapy, previous surgeries, or a tumor located in a difficult area.

Purpose

This procedure primarily aims to remove cancerous or abnormal tissue from the bladder while preserving bladder function. It addresses conditions such as muscle-invasive bladder cancer or recurrent tumors.

Indications

• Muscle-invasive bladder cancer confined to a specific area
• Recurrent bladder tumors resistant to other treatments
• Situations where radical cystectomy (complete bladder removal) is not feasible

Preparation

• Patients may be required to fast for several hours before the surgery.
• A series of diagnostic tests such as imaging studies (CT scan, MRI), blood tests, and a cystoscopy are usually performed.
• Pre-operative consultations might include meeting with the surgical team, anesthesiologist, and possibly a nutritionist or physiotherapist for comprehensive care planning.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia.
2. Incision: The surgeon makes an incision in the lower abdomen to access the bladder.
3. Excision: Using specialized surgical tools, the surgeon carefully removes the diseased portion of the bladder.
4. Reconstruction: The remaining bladder tissue is restructured to ensure proper function.
5. Final Steps: The incision is closed with sutures or staples.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity.

Setting

Partial cystectomy is usually performed in a hospital setting, in an operating room equipped for advanced surgeries.

Personnel

• Urological surgeons
• Anesthesiologist
• Surgical nurses
• Operating room assistants

Risks and Complications

• Common risks: Bleeding, infection, blood clots
• Serious complications: Injury to surrounding organs, urinary incontinence, bowel obstruction
• Management: Post-operative monitoring and interventions to address complications promptly

Benefits

• Preservation of bladder function
• Removal of cancerous tissues
• Potentially decreases the need for more extensive surgery

Recovery

• Patients may stay in the hospital for several days post-surgery.
• Instructions include wound care, managing a temporary catheter if needed, and gradual return to normal activities.
• Full recovery usually takes 6 to 8 weeks, with follow-up appointments to monitor healing and bladder function.

Alternatives

• Radical Cystectomy: Complete removal of the bladder, which may involve more significant lifestyle changes and longer recovery.
• Radiation Therapy: Less invasive but may not be as effective for certain stages of bladder cancer.
• Chemotherapy: Often used in conjunction with surgery or when surgery is not an option.

Patient Experience

Patients are likely to be under general anesthesia during the procedure, so they will not feel pain during the surgery. Post-operative pain is managed with medication. Patients might experience discomfort, fatigue, or temporary difficulty with urination, which will improve as they heal.