Name of the Procedure:

Cystectomy, Complete with Continent Diversion (Neobladder Construction)

Summary

A complete cystectomy with continent diversion is a surgical procedure to remove the entire bladder and create a new bladder (neobladder) from parts of the small and/or large intestine. This helps the patient to store and pass urine normally, without the need for an external urine collection bag.

Purpose

This procedure is often performed to treat bladder cancer or severe bladder dysfunction. The goals are to eliminate disease, restore the ability to store and void urine voluntarily, and maintain quality of life.

Indications

• Bladder cancer that has invaded the muscle layer
• Severe bladder dysfunction not amenable to other treatments
• High-risk patients with recurrent bladder issues or abnormalities

Preparation

• Preoperative fasting (usually 8 hours before surgery)
• Bowel preparation as directed by the healthcare provider
• Discontinuation or adjustment of certain medications (e.g., blood thinners)
• Preoperative imaging (CT scan, MRI) and lab tests (blood tests, urine tests)

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: An abdominal incision is made to access the bladder.
3. Bladder Removal: The bladder is carefully detached and removed.
4. Neobladder Construction: A portion of the small and/or large intestine is reshaped to create a new bladder.
5. Connection: The neobladder is connected to the urethra to allow urine passage.
6. Closure: The abdominal incision is closed with sutures or staples.

Tools and equipment used include surgical knives, sutures, staplers, and specialized instruments for manipulating and suturing the intestine.

Duration

The procedure typically takes 4 to 6 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Urologic surgeon
• Surgical assistants
• Anesthesiologist
• Nursing team

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Urine leakage
• Neobladder malfunction or obstruction
• Bowel obstruction

Benefits

• Effective removal of bladder cancer or source of severe dysfunction
• Ability to store and pass urine normally
• Improved quality of life compared to external urine collection methods

Recovery

• Hospital stay of 5 to 7 days post-surgery
• Pain management with prescribed medications
• Gradual return to normal activities over 4 to 6 weeks
• Follow-up appointments for monitoring recovery and function of the neobladder
• Instructions on catheter usage for initial period, if needed

Alternatives

• Partial cystectomy (removal of part of the bladder)
• Radical cystectomy with an external urine collection system (e.g., urostomy)
• Chemotherapy or radiation therapy for non-surgical candidates

Alternatives may be less invasive but could come with their own risks and benefits.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-surgery, there will be pain and discomfort managed with medications. Patients may have a catheter initially to drain urine. Gradual recovery involves learning to use the neobladder effectively.

Pain management plans and comfort measures will be provided to ease the recovery process.