Name of the Procedure:

Cystectomy, Complete with Ureteroileal Conduit or Sigmoid Bladder (including Intestine Anastomosis)

Summary

A cystectomy involves the surgical removal of the urinary bladder. In a complete cystectomy with a ureteroileal conduit or sigmoid bladder, the surgeon creates a new pathway for urine to exit the body, using a section of the patient's intestine.

Purpose

A complete cystectomy is typically performed to treat bladder cancer or other severe urinary problems. The goal is to remove the diseased bladder and create a new way for urine to be expelled from the body, either through an external stoma (ureteroileal conduit) or by creating a new internal bladder (sigmoid bladder).

Indications

• Bladder cancer
• Severe traumatic injury to the bladder
• Interstitial cystitis (when other treatments have failed)
• Congenital abnormalities causing severe bladder dysfunction

Preparation

• Patients are usually required to fast (no food or drink) for about 8 hours before the procedure.
• Pre-operative tests may include blood tests, imaging studies (like a CT scan or MRI), and a discussion about medical history.
• Patients might need to stop certain medications, as advised by their doctor, especially blood thinners.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdomen to access the bladder.
3. The urinary bladder is carefully separated from surrounding tissues and removed.
4. The surgeon selects a segment of the intestine to use for the new urinary diversion.
5. Ureters are connected to the chosen intestinal segment.
   • For a ureteroileal conduit, one end of the intestinal segment is brought out through the abdominal wall to create a stoma.
   • For a sigmoid bladder, the segment is fashioned into a reservoir and attached to the urethra, or an alternative path for urine to exit the body.
6. Intestinal anastomosis is performed to reconnect the remaining intestines.
7. The incision is closed, and a catheter may be placed to facilitate urine drainage during initial recovery.

Duration

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

Setting

The procedure is performed in a hospital's operating room.

Personnel

• Urologist/Surgeon
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Bowel obstruction
• Leakage at the surgery site
• Kidney damage
• Urinary tract infections
• Need for additional surgeries

Benefits

• Improved quality of life by removing diseased or damaged bladder
• Reduced symptoms and complications related to bladder conditions
• Potential for increased survival rates in cancer patients

Recovery

• Hospital stay for about 7 to 10 days
• Pain management with prescribed medications
• Instructions on caring for the stoma (if applicable) or new urinary reservoir
• Avoid strenuous activity for at least 4 to 6 weeks
• Follow-up appointments to monitor healing and adjust care as needed

Alternatives

• Partial cystectomy (only part of the bladder is removed)
• Radiation therapy
• Chemotherapy
• Bladder-sparing surgeries depending on the condition
• Each alternative has its own risks and benefits and should be discussed with a healthcare provider.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel anything. Post-surgery, the patient may experience pain, managed by medications. Initial discomfort from the stoma or new reservoir requires adjustment and learning how to manage the new urinary system. Support from healthcare providers includes pain management and care instructions to aid recovery.