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Partial and radical cystectomy

Cystectomy is an operation which is performed to remove the urinary bladder due to a medical problem. The most common indications for cystectomy include the presence of bladder cancer, birth defects which involve the urinary system and inflammatory or neurological disorders which affect the urinary system.

Types of cystectomy

There are two main types of cystectomy.

  • Partial cystectomy is the surgical procedure in which only the damaged part of the urinary bladder is removed.
  • Radical cystectomy is the surgical procedure in which the entire bladder is removed along with a part of the urethra and the surrounding lymph nodes. Additionally, radical cystectomy in men involves the removal of the prostate gland and seminal vesicles while in women it involves the removal of uterus, a portion of the vagina and ovaries.

The type of surgery depends on factors such as the overall health of the patient, condition to be treated, etc.

Preparation before the surgery

The following preparation is required before undergoing a cystectomy:

  • Inform the doctor about all the medicines, supplements and herbal products which are in use. The doctor may advice whether to continue such products or not.
  • Avoid smoking for some days before the surgery as it can interfere with the healing process and can increase the risk of complications after the surgery.
  • Do not eat or drink anything the previous night before the surgery and until the surgery is complete.
  • Take only those medicines which the surgeon suggests are essential with a small sip of water.

Procedure

Before performing any of the below procedures, the surgeon gives a general anesthesia or a local anesthesia to cause numbness. Therefore, the patient does not feel pain during the surgery.

The surgical options include:

  • Open cystectomy is the method in which a single large incision (cut) is made in the abdomen to remove the bladder or other parts.
  • Laparoscopic cystectomy is a minimally invasive surgery in which several small cuts are made on the skin surface of the abdomen. Through these cuts the necessary tools and video camera are inserted to access the pelvis and bladder.
  • Robotic cystectomy is similar to laparoscopic cystectomy. However, in this method the surgeon sits in a console and operates a robot which carries out the surgery.

Both laparoscopic and robotic surgeries are associated with lesser risk and scarring. Also, the recovery with these techniques is faster.

Once the damaged parts are removed, a new route of urinary tract is created and the incision is closed with sutures. These sutures dissolve in some days.

After the procedure

  • The patient will have to stay in the hospital for about 5-6 days until the intestines are ready to absorb the food and nutrients.
  • Some of the symptoms which may be experienced by the patient include sleepiness, dry mouth, sore throat, nausea and vomiting. However, these symptoms may fade away in some days after the surgery.
  • There may be some amount of mucus and blood in urine for some days which will gradually disappear.
  • It is advisable to walk on the same day to promote circulation and bowel movements and prevent blood clots and joint stiffness.
  • Pain relievers are given to relive the pain at the incision site. These may be continued for some days as suggested by the doctor. 
  • Solid foods should be avoided for some days as suggested by the surgeon.

Post-operative care

The following care is necessary to help in a faster recovery after the surgery:

  • Go for regular follow-up visits whenever required. During these visits, the doctor will check if the urinary symptoms are still present.
  • Do not perform heavy activities such as lifting, driving, etc. for about 6-8 weeks after the surgery.
  • Take the medicines as prescribed without missing any dose.

Risks

Due to the manipulation of the organs in the abdomen, cystectomy can cause certain complications. Some of them are life-threatening while others are not. They include the below:

  • Bleeding from the site of incision
  • Infection of the surgical site
  • Pneumonia
  • Heart attack
  • Blood clots which can travel from legs to lungs
  • Urinary tract infections
  • Dehydration
  • Electrolyte imbalances
  • Obstruction in the bowel movements
  • Blockage of the ureters (the tubes that carry urine out from the kidneys)
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