Understanding Radical Cystectomy: What to Expect

Radical cystectomy is a major surgical procedure often performed to treat bladder cancer. If your doctor has recommended this surgery, you may have many questions and concerns.

This article aims to provide a comprehensive overview of what to expect before, during, and after a radical cystectomy, including indications, the procedure itself, recovery, and potential complications.

What is a Radical Cystectomy?

A radical cystectomy is the surgical removal of the entire bladder. In men, this procedure often includes the removal of the prostate and seminal vesicles. In women, it may involve the removal of the uterus, ovaries, and part of the vaginal wall.

This surgery is primarily performed to treat invasive bladder cancer, but it may also be indicated for other conditions such as recurrent non-invasive bladder cancer or severe bladder dysfunction.

Indications for Radical Cystectomy

Bladder Cancer

The most common indication for a radical cystectomy is bladder cancer. This surgery is typically recommended when cancer has invaded the muscle layer of the bladder wall or when non-invasive cancer is high-grade and recurrent. In some cases, it may also be suggested for patients with carcinoma in situ that has not responded to other treatments.

Other Medical Conditions

While bladder cancer is the primary reason for this surgery, other conditions might necessitate a radical cystectomy. These include severe bladder dysfunction due to chronic inflammation, interstitial cystitis, or congenital abnormalities.

The Radical Cystectomy Procedure

Preoperative Preparation

Before undergoing a radical cystectomy, you will have several preoperative tests, including blood tests, imaging studies, and possibly a cystoscopy. Your doctor will provide specific instructions on how to prepare for the surgery, which may include fasting and bowel preparation.

The Surgery

A radical cystectomy can be performed using open surgery or minimally invasive techniques such as laparoscopic or robotic-assisted surgery. The choice of method depends on various factors, including the surgeon's expertise and the patient's overall health.

During the procedure, the surgeon will make an incision in the lower abdomen to access and removal of the bladder and other affected organs. Once the bladder is removed, the surgeon will create a urinary diversion to allow urine to exit the body.

There are several types of urinary diversions:

• Ileal conduit: A small piece of the small intestine is used to create a tube through which urine flows into an external bag.
• Continent urinary reservoir: A pouch is created inside the body using a piece of the intestine, which stores urine until it is emptied through a catheter.
• Neobladder: A new bladder is constructed from a piece of the intestine, allowing the patient to urinate normally.

Recovery After Radical Cystectomy

Immediate Postoperative Care

After surgery, you will be moved to a recovery room, where you will be closely monitored. Pain management is an essential aspect of postoperative care. You may receive pain medications through an intravenous (IV) line, and as you recover, you will transition to oral pain relievers.

Hospital Stay

The typical hospital stay after a radical cystectomy is about 7-10 days. During this time, the medical team will monitor your recovery, manage pain, and begin the process of teaching you how to care for your new urinary diversion. You will also be encouraged to start moving around as soon as possible to reduce the risk of blood clots and pneumonia.

At-Home Recovery

Once discharged, you will continue to recover at home. It's important to follow your doctor's instructions regarding wound care, activity restrictions, and diet. You may need assistance with daily activities to stay active initially, and you will likely have follow-up appointments to monitor your progress and address any concerns.

Potential Complications of Radical Cystectomy

Surgical Risks

As with any major surgery, radical cystectomy carries risks. These can include bleeding, infection, blood clots, and complications related to anaesthesia. Your surgeon will discuss these risks with you before the procedure.

Urinary Diversion Complications

Complications specific to the urinary diversion may also occur. These can include:

• Infection: Both internal and external urinary diversions can become infected, requiring prompt medical attention.
• Urine leakage: There may be issues with urine leaking from the diversion site, which may need further surgical intervention.
• Blockages: The new urinary pathway can become blocked, leading to kidney damage if not addressed promptly.

Long-Term Considerations

Living with a urinary diversion requires ongoing management. Patients with an ileal conduit will need to learn how to care for the stoma and change the external bag. Those with a continent reservoir or neobladder will need to learn catheterization techniques or train their new bladder to hold and release urine.

Life After Radical Cystectomy

Emotional and Psychological Impact

A radical cystectomy can have significant emotional and psychological effects. Adjusting to life with a urinary diversion can be challenging, and it's essential to seek support from healthcare professionals, support groups, or counselors.

Physical Activity

Most patients can return to normal physical activities within a few months after surgery. However, it's crucial to avoid heavy lifting and strenuous exercise until your doctor gives you the green light.

Diet and Nutrition

Maintaining a healthy diet is vital for recovery and long-term health. Your healthcare team may provide specific dietary recommendations, especially if you have a continent reservoir or neobladder.

Conclusion

Radical cystectomy is a complex but potentially life-saving surgery primarily used to treat invasive bladder cancer. Understanding what to expect before, during, and after the procedure can help you prepare for the journey ahead.

While the surgery and recovery process can be daunting, advancements in surgical techniques and postoperative care have improved outcomes and quality of life for many patients. Always consult with your healthcare provider for personalized advice and support throughout your treatment and recovery.

Frequently Asked Questions