Cystectomy is a major surgical procedure primarily used to treat bladder cancer, although it may also be performed for other conditions such as interstitial cystitis, bladder trauma, or severe congenital abnormalities. The operation involves the removal of all or part of the bladder, and in many cases, it includes a reconstructive step to create a new way for urine to exit the body. While cystectomy can be life-saving and significantly improve quality of life for some patients, it is a complex and invasive surgery that carries potential risks and complications, both short-term and long-term.

Understanding the possible risks and complications of cystectomy surgery is essential for patients and caregivers to make informed decisions and prepare for post-operative recovery.

Risks and Complications of Cystectomy Surgery

There are two main types of cystectomy: partial and radical. A partial cystectomy removes only a portion of the bladder, usually when cancer is limited to one area. A radical cystectomy involves removing the entire bladder and often includes nearby organs such as the prostate in men or the uterus and part of the vagina in women.

Due to the complexity of radical cystectomy, particularly when followed by urinary reconstruction (e.g., ileal conduit, neobladder, or continent urinary reservoir), the risk profile is higher. Surgical technique, patient health, and the presence of other medical conditions can influence outcomes.

Common Surgical Risks

As with any major operation, cystectomy carries general surgical risks. These may include:

Infection :- Postoperative infections are relatively common and can occur at the site of the incision, in the urinary tract, or even systemically. Surgical wounds are particularly susceptible to bacteria, especially if proper hygiene is not maintained or if the immune system is weakened. Infections may require antibiotics or additional medical intervention.
Bleeding :- Blood loss during or after cystectomy is a significant concern. Some patients may need blood transfusions. Surgeons take careful measures to control bleeding, but the extent of the surgery can still result in considerable blood loss.
Blood Clots :- Deep vein thrombosis (DVT) and pulmonary embolism (PE) are serious complications following cystectomy. Due to prolonged periods of immobility during and after surgery, patients are at risk of developing blood clots, particularly in the legs. Preventative steps include early mobilization, compression devices, and anticoagulant medications.

Anesthetic Complications

General anesthesia has its own risks, such as allergic reactions, breathing problems, or cardiovascular issues, especially in patients with preexisting conditions like heart disease or lung problems.

Organ Injury :- Cystectomy is performed in close proximity to other organs. There’s a risk of unintentional injury to the intestines, ureters, reproductive organs, or blood vessels. In some cases, additional surgery may be required to address such injuries.

Complications Related to Urinary Diversion :- After a radical cystectomy, the surgeon must create a new method for urine storage and elimination. This process, known as urinary diversion, introduces additional risks depending on the technique used.

Ileal Conduit Risks :- This method reroutes the ureters to a small segment of the intestine that exits through the abdominal wall into a stoma. Potential issues include stoma blockage, urinary tract infections, hernias around the stoma, and skin irritation from the collection appliance.
Neobladder Complications :- A neobladder is a surgically constructed bladder made from intestinal tissue. While it can restore more natural urination, it may cause issues such as urinary leakage, difficulty emptying the bladder, urinary retention, or even the need for catheterization. Additionally, because the neobladder lacks the same nerve signals as a natural bladder, it may not give the sensation of fullness.
Continent Reservoir Risks
This type of diversion involves a pouch made from intestine that holds urine inside the body. The patient drains it through a stoma using a catheter. Potential complications include pouch leakage, catheter-related infections, and narrowing of the stoma.

Gastrointestinal Complications

Manipulating or removing parts of the intestine during surgery can lead to gastrointestinal issues. Common problems include:

Ileus :- This is a temporary stoppage of normal bowel movement and can cause nausea, vomiting, abdominal bloating, and pain. It often requires patients to remain in the hospital longer and may delay oral feeding.
Bowel Obstruction :- Scar tissue from the surgery can lead to bowel obstruction, which may require further surgery if it doesn’t resolve with conservative treatment.
Nutritional Deficiencies :-If a significant length of intestine is removed or rerouted, the absorption of certain nutrients may be impaired, leading to long-term nutritional challenges that require monitoring and supplementation.
Sexual Dysfunction :- Cystectomy can significantly impact sexual function due to the removal or damage to nerves and nearby organs. In men, the removal of the prostate and seminal vesicles can result in erectile dysfunction and infertility. In women, the removal of part of the vagina or uterus may lead to vaginal shortening, dryness, or discomfort during intercourse. Emotional factors and changes in body image can also affect sexual health. In many cases, rehabilitation, counseling, and medical interventions may help.
Urinary Incontinence and Control Issues :- Loss of bladder control is a concern depending on the type of urinary diversion. Neobladders may lead to incontinence, especially during sleep. In other cases, incomplete emptying or the need for catheterization may be a long-term necessity.

Psychological and Emotional Effects

Undergoing a major surgery like cystectomy and adapting to life after bladder removal can have profound psychological effects. Anxiety, depression, and body image issues are common. Adjusting to life with a stoma or catheter, coping with sexual changes, and facing long-term medical follow-up can be overwhelming.

Support from healthcare professionals, counselors, and peer support groups can make a significant difference in helping patients adapt both emotionally and practically.

Long-Term Risks and Follow-Up

Even after a successful recovery, patients may face long-term risks that require ongoing management.

Recurrence of Cancer :- For those undergoing cystectomy due to cancer, there is always a risk of cancer recurrence in nearby lymph nodes or distant organs. Regular monitoring through imaging and lab tests is essential.
Kidney Function :- Because urinary flow is rerouted, kidney function must be closely monitored. Obstruction, infection, or other complications can lead to progressive kidney damage over time.
Hernias and Abdominal Wall Issues :- Incisional hernias or parastomal hernias can develop months or years after surgery, especially in patients who have had open rather than laparoscopic procedures. Some cases may require surgical repair.

Conclusion

While cystectomy can be a vital and often life-saving procedure, it is not without substantial risks and long-term consequences. Understanding these risks helps patients and families set realistic expectations, prepare for recovery, and stay vigilant for complications. With the right support system and close follow-up with healthcare providers, many individuals go on to lead active, meaningful lives after bladder removal surgery.

If you or a loved one is facing cystectomy, discussing the specific risks and benefits with your surgeon and care team is essential. Personalized care, proper education, and emotional support can greatly improve outcomes and quality of life post-surgery.