51565 Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy)

Name of the Procedure:

Cystectomy, partial, with reimplantation of ureter(s) into bladder (ureteroneocystostomy)

Summary

A partial cystectomy with ureteroneocystostomy is a surgical procedure that involves removing a part of the bladder and reattaching the ureter(s) to a new location on the bladder. This is performed to treat certain bladder conditions or cancers while preserving bladder function.

Purpose

Medical Conditions Addressed:

• Bladder cancer confined to a specific area.

• Severe bladder damage or congenital defects affecting urination.

  Goals:

• To remove diseased or damaged portions of the bladder.
• To ensure proper urine flow from the kidneys to the bladder.
• To maintain as much bladder function as possible.

Indications

Symptoms & Conditions:

• Localized bladder cancer.
• Ureteral obstruction or damage.
• Congenital bladder abnormalities.
• Severe trauma to the bladder.

Patient Criteria:

• The disease is confined to one area of the bladder.
• The patient is otherwise healthy enough for surgery.
• Prior treatments (e.g., chemotherapy, radiation) have not been effective.

Preparation

• Fasting for 8 hours prior to surgery.
• Medication adjustments as advised by the physician.
• Preoperative imaging tests such as CT scans or MRIs.
• Blood tests and a thorough medical evaluation.

Procedure Description

1. The procedure begins with administering general anesthesia.
2. The surgeon makes an incision in the lower abdomen to access the bladder.
3. The diseased or damaged portion of the bladder is identified and removed.
4. The ureters are detached from their original insertion points.
5. The ureters are then reattached to a new, healthy part of the bladder (ureteroneocystostomy).
6. Surgical instruments like scalpels, sutures, and possibly laparoscopic tools are used.
7. The incision is closed with sutures or staples.

Duration

The procedure typically takes 3 to 5 hours.

Setting

The procedure is performed in a hospital under sterile conditions in an operating room.

Personnel

• Urologist or specialized surgeon.
• Anesthesiologist.
• Surgical nurses.
• Operating room technicians.

Risks and Complications

Common Risks:

• Infection.
• Bleeding.

Rare Risks:

• Ureteral stricture (narrowing).
• Bladder leakage.
• Blood clots.
• Anesthesia-related complications.

Management:

• Antibiotics for infection.
• Blood transfusions for significant blood loss.
• Follow-up imaging to monitor healing.

Benefits

• Removal of localized bladder cancer or damaged tissue.
• Improved urinary function.
• Reduced risk of cancer spread.
• Preservation of bladder function.

Recovery

• Hospital stay of 5 to 7 days post-surgery.
• Pain management with prescribed medications.
• Instructions to avoid strenuous activity for several weeks.
• Catheter use for a few days to ensure proper urinary drainage.
• Follow-up appointments for monitoring healing.

Alternatives

• Radical cystectomy (complete bladder removal).
• Radiation therapy.
• Chemotherapy.
• Minimally invasive options like transurethral resection.

Pros and Cons:

• Radical cystectomy is more extensive but may be more effective for widespread cancer.
• Non-surgical treatments might be less invasive but may not be suitable for all patients.

Patient Experience

During Procedure:

• Patient will be under general anesthesia and will not feel anything.

After Procedure:

• Expect some abdominal discomfort and soreness.
• Pain managed with medications.
• Possible temporary use of a urinary catheter.
• Gradual return to normal activity levels over several weeks.