Name of the Procedure:

Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

Summary

A complete cystectomy is a surgical procedure that involves the removal of the entire bladder. Bilateral pelvic lymphadenectomy is conducted to remove lymph nodes in the pelvic area, including the external iliac, hypogastric, and obturator nodes, to check for the spread of cancer.

Purpose

This procedure is primarily performed to treat bladder cancer that has invaded the muscular wall of the bladder or in cases where cancer persists despite other treatments. The goal is to eliminate the cancerous tissues and prevent the spread of the disease to other parts of the body.

Indications

• Muscle-invasive bladder cancer
• High-grade non-muscle-invasive bladder cancer that is unresponsive to other treatments
• Recurrent bladder cancer
• Large or multiple bladder tumors

Preparation

• Patients may be required to fast for 8-12 hours before the surgery.
• Pre-operative diagnostics may include blood tests, imaging studies (CT scan, MRI), and a thorough physical evaluation.
• Patients might need to stop certain medications as advised by their doctor.
• Bowel preparation might be necessary to clear the intestines.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia to ensure they are asleep and pain-free during the surgery.
2. Incision: An incision is made in the lower abdomen.
3. Bladder Removal: The entire bladder is carefully removed.
4. Lymphadenectomy: Lymph nodes in the pelvic area, including the external iliac, hypogastric, and obturator nodes, are excised for examination.
5. Urinary Diversion: A new way for urine to exit the body is created, either through a segment of the intestine (ileal conduit) or by constructing a new bladder (neobladder).
6. Closure: The surgical site is closed with sutures or staples, and a catheter is often placed to allow urine to drain.

Duration

The procedure typically takes 4-6 hours, depending on the complexity.

Setting

The procedure is performed in a hospital's surgical suite.

Personnel

• Urologic Surgeon
• Surgical Assistants
• Anesthesiologist
• Operating Room Nurses

Risks and Complications

• Bleeding
• Infection
• Blood clots
• Injury to surrounding organs
• Urinary leakage or incontinence
• Complications related to anesthesia
• Strictures or narrowing at the site of urinary diversion

Benefits

• Potential cure or significant control of bladder cancer.
• Prevention of cancer spread.
• Relief from symptoms such as bleeding, pain, and urinary obstruction.

Recovery

• Hospital stay of 7-10 days post-surgery.
• Pain management with prescribed medications.
• Instructions on catheter care and wound care.
• Limited physical activity for several weeks.
• Follow-up appointments with the healthcare provider.
• Full recovery may take several months.

Alternatives

• Partial cystectomy (removal of part of the bladder)
• Radiation therapy
• Chemotherapy
• Immunotherapy
• Clinical trials for newer treatments

Each alternative comes with its own advantages and limitations, which should be discussed with a healthcare provider.

Patient Experience

• During the procedure, the patient will be under anesthesia and won't feel anything.
• Post-surgery, patients may experience pain and discomfort, managed with medications.
• Initially, patients will have tubes for urine drainage and need to learn new ways to urinate if a urinary diversion is performed.
• Emotional and psychological support may be helpful for adjusting to life after surgery.