Name of the Procedure:

Complete Cystectomy with Ureteroileal Conduit or Sigmoid Bladder and Intestine Anastomosis; Bilateral Pelvic Lymphadenectomy Including External Iliac, Hypogastric, and Obturator Nodes

Summary

A complete cystectomy involves the surgical removal of the entire bladder. This procedure includes the creation of a new urinary diversion (either a ureteroileal conduit or a sigmoid bladder) using parts of the intestine and the resection of lymph nodes in the pelvic region.

Purpose

The procedure is primarily performed to treat bladder cancer that is invasive and localized but has not yet spread to distant parts of the body. The goal is to remove the cancerous bladder and associated lymph nodes to eliminate cancer and prevent its spread.

Indications

• Diagnosed invasive bladder cancer
• Recurrent non-muscle invasive bladder cancer that has not responded to other treatments
• Severe bladder dysfunction or damage Patients typically need to be otherwise in sound health except for their bladder condition, as this is a significant surgery.

Preparation

• Patients may need to fast for several hours before the surgery.
• Instructions on adjusting any current medications, particularly blood thinners.
• Pre-surgical tests including blood work, imaging studies (CT scan, MRI), and possibly an EKG.
• Bowel preparation may be required for the use of intestinal segments.

Procedure Description

1. Anesthesia: Administer general anesthesia.
2. Incision: Make an incision in the lower abdomen.
3. Bladder removal: Surgically remove the entire bladder.
4. Lymphadenectomy: Remove lymph nodes in the pelvic region, including the external iliac, hypogastric, and obturator nodes.
5. Creation of diversion:
   • Ureteroileal Conduit: Use a segment of the small intestine to create a passage for urine to exit the body into a stoma (an opening on the abdomen).
   • Sigmoid Bladder: Use a segment of the sigmoid colon to create a new bladder.
6. Intestinal anastomosis: Reattach the remaining parts of the intestine to ensure proper gastrointestinal function.
7. Closure: Close the incisions with sutures or staples.

Duration

The procedure typically takes 4 to 6 hours to complete.

Setting

Performed in a hospital operating room, often requiring an extended hospital stay post-operation.

Personnel

• Lead Surgeon (urologist specialized in cancer)
• Assistant Surgeons
• Anesthesiologist
• Surgical Nurses
• Possibly a Colorectal Surgeon (for intestinal work)

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Damage to surrounding organs
• Anesthetic complications
• Urinary leakage or dysfunction
• Digestive issues related to the use of intestinal segments
• Possible need for further surgical intervention

Benefits

• Removal of cancerous tissue
• Potentially curative for bladder cancer
• Can improve life expectancy and quality of life if cancer is successfully removed and does not recur

Recovery

• Initial hospital stay for 1-2 weeks
• Pain management and monitoring for complications
• Restricted activity for several weeks, avoiding heavy lifting
• Follow-up appointments for monitoring recovery and checking for cancer recurrence
• Instructions on care for the stoma or new bladder, including hygiene and possibly catheter use

Alternatives

• Partial cystectomy (only part of the bladder is removed)
• Radical cystectomy without lymphadenectomy
• Radiation therapy
• Chemotherapy alone or in combination with other treatments
• Pros: less invasive options have a quicker recovery; Cons: may be less effective in completely removing cancer

Patient Experience

During the procedure, the patient will be under general anesthesia and unaware. Post-procedure, expect some pain and discomfort managed by medications. Patients may experience fatigue and limited activity for several weeks. Adjustments to living with a stoma or new bladder shape life post-surgery.