Name of the Procedure:

Cystectomy, complete; (separate procedure)

Common Name(s): Complete Cystectomy

Technical or Medical Term: Radical Cystectomy

Summary

A complete cystectomy is a surgical procedure to remove the bladder. This procedure is typically used to treat bladder cancer or other serious bladder diseases. It involves the removal of the bladder and sometimes nearby organs that might be affected, such as parts of the reproductive system.

Purpose

Medical Condition or Problem It Addresses:

• Bladder cancer
• Severe bladder dysfunction
• Interstitial cystitis
• Birth defects of the bladder

Goals or Expected Outcomes:

• Removal of cancerous or dysfunctional tissue
• Prevention of cancer spread
• Improvement in quality of life

Indications

Specific Symptoms or Conditions:

• Hematuria (blood in the urine)
• Frequent urinary tract infections
• Pain or discomfort in the pelvic region
• High-grade bladder cancer
• Bladder that does not function properly due to chronic illness

Patient Criteria or Factors:

• Confirmed diagnosis of bladder cancer
• Failed conservative treatments for bladder dysfunction
• Patients who are otherwise in good enough health to undergo major surgery

Preparation

Pre-procedure Instructions:

• Fasting for 8-12 hours before surgery
• Possible bowel preparation (laxatives or enema)
• Discussing medication adjustments with your doctor, particularly blood thinners
• Stopping smoking, as it can affect healing

Diagnostic Tests or Assessments:

• Blood tests
• Imaging studies (CT scan, MRI, Ultrasound)
• Cystoscopy (a procedure to examine the inside of the bladder)
• Electrocardiogram (EKG) to check heart function

Procedure Description

Step-by-Step Explanation:

1. Anesthesia: General anesthesia is administered to ensure the patient remains unconscious and pain-free during the procedure.
2. Incision: Surgeons make an incision in the lower abdomen.
3. Bladder Removal: The bladder is carefully detached and removed. In men, the prostate and seminal vesicles may also be removed. In women, parts of the reproductive organs such as the uterus, ovaries, and part of the vaginal wall might be removed.
4. Urinary Diversion: An alternative way for urine to be stored and expelled from the body is created. Options include a urostomy, a continent urinary reservoir, or a neobladder.
5. Closing Incision: The incision is closed with sutures or staples.

Tools and Equipment:

• Surgical scalpel
• Laparoscopic or robotic instruments (optional)
• Catheters
• Anesthesia equipment

Anesthesia:

• General anesthesia is commonly used.

Duration

The procedure typically takes 4-8 hours, depending on complexity.

Setting

Performed in a hospital operating room.

Personnel

• Urologic Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Blood clots

Rare Risks:

• Damage to surrounding organs
• Urinary tract issues
• Sexual dysfunction

Possible Complications:

• Deep vein thrombosis (DVT)
• Pneumonia
• Anesthetic reactions

Benefits

Expected Benefits:

• Removal of cancerous tissue
• Potential for cancer cure or significant remission
• Improvement in quality of life and symptom relief

Realization Timeframe:

• Varies; immediate for symptom relief, longer for cancer outcomes.

Recovery

Post-procedure Care:

• Hospital stay for 7-10 days
• Pain management with medications
• Support for urinary diversion education

Expected Recovery Time:

• 6-8 weeks for initial recovery
• Full recovery might take several months

Restrictions and Follow-Up:

• Avoid heavy lifting for at least 6 weeks
• Follow a prescribed diet if a new urinary diversion is created
• Regular follow-up appointments with the surgeon and oncologist

Alternatives

Other Treatment Options:

• Partial cystectomy
• Chemotherapy and radiation (for non-surgical candidates)
• Bladder-sparing surgery

Pros and Cons:

• Alternative treatments may preserve more of the bladder but might not be as effective in removing all cancer.

Patient Experience

During the Procedure:

• Patients will not feel or remember the procedure due to general anesthesia.

After the Procedure:

• Initial pain and discomfort, managed with pain relief medications
• Learning to manage new urinary diversion
• Gradual return to normal activities

Pain Management and Comfort Measures:

• Pain medication regimen
• Support with mobility and daily activities in the hospital setting
• Ongoing monitoring for complications