Types of Cystectomy Surgery

Cystectomy is a surgical procedure involving the removal of all or part of the urinary bladder. It is most commonly performed to treat bladder cancer, but it can also be used for other conditions such as severe bladder dysfunction or interstitial cystitis. The decision to undergo a cystectomy is significant, and understanding the different types of cystectomy surgery is crucial for patients and their families.

There are several approaches to cystectomy, each tailored to the patient’s diagnosis, health status, and treatment goals.

What Is Cystectomy?

Cystectomy refers to the surgical removal of the bladder. Depending on the extent of the disease and the patient’s condition, surgeons may remove only part of the bladder or the entire bladder. In some cases, surrounding organs and lymph nodes may also need to be removed to ensure the cancer does not spread or recur.

The two broad categories of cystectomy are partial cystectomy and radical cystectomy, with each offering specific benefits and implications for recovery and long-term function.

Partial Cystectomy

Partial cystectomy involves removing only the portion of the bladder that contains the tumor or damaged tissue. The rest of the bladder remains intact, allowing the patient to maintain some or most normal bladder function.

When is Partial Cystectomy Used?

Partial cystectomy is typically recommended in select cases where:

• The tumor is localized and not invasive
• The tumor is in a part of the bladder that can be easily removed
• Preserving bladder function is a priority

This procedure is less common than radical cystectomy but can be an excellent option for patients with specific tumor types or early-stage bladder cancer.

Benefits and Considerations

Partial cystectomy preserves more of the bladder, which can lead to a faster recovery and fewer changes in urinary habits. However, there’s a chance that the remaining bladder tissue could develop new tumors in the future, so ongoing surveillance is essential.

Radical Cystectomy

Radical cystectomy is a more extensive procedure involving the removal of the entire bladder. In men, this surgery may also include the removal of the prostate and seminal vesicles. In women, it can involve the removal of the uterus, ovaries, fallopian tubes, and part of the vaginal wall, depending on the spread of disease.

This is the standard treatment for muscle-invasive bladder cancer and for high-grade tumors that are likely to recur or spread.

Types of Cystectomy Surgery

There are three primary techniques for performing a radical cystectomy:

• Open Radical Cystectomy :- Open cystectomy is the traditional surgical method. The surgeon makes a large incision in the lower abdomen to access and remove the bladder. This approach offers direct visibility and is preferred in complex cases or when reconstruction is needed.
• Laparoscopic Radical Cystectomy :- Laparoscopic cystectomy uses small incisions and specialized instruments. A tiny camera (laparoscope) is inserted through one of the incisions, giving the surgeon a view of the internal organs on a monitor. This approach offers benefits such as less postoperative pain, shorter hospital stay, and quicker recovery. However, it requires a highly skilled surgical team and may not be suitable for all patients.
• Robot-Assisted Radical Cystectomy :- Robotic surgery is a type of laparoscopic cystectomy where the surgeon operates using a robotic system. The robotic arms provide high precision and flexibility, making it easier to perform delicate procedures.

Robot-assisted surgery is increasingly popular due to its minimally invasive nature, reduced blood loss, and faster recovery. It also allows for precise nerve-sparing techniques that may help preserve sexual and urinary function.

1. Urinary Diversion Methods After Radical Cystectomy

   After radical cystectomy, the body needs a new way to store and pass urine since the bladder has been removed. This is achieved through urinary diversion, and there are several options available depending on the patient’s age, lifestyle, health condition, and personal preference.

   • Ileal Conduit :- An ileal conduit is the most common form of urinary diversion. A short piece of the small intestine (ileum) is removed and used to create a passage for urine to exit the body through an opening in the abdominal wall (a stoma). A urine collection bag is worn outside the body. This method is relatively simple and has a shorter recovery time. However, it requires the lifelong use of an external bag and regular stoma care.
   • Continent Cutaneous Reservoir :- This option also uses a segment of the intestine to create an internal pouch for storing urine. A stoma is created on the abdomen, but instead of using an external bag, the patient drains urine using a catheter several times a day. It offers more control and avoids an external appliance, but patients must be comfortable with regular self-catheterization.
   • Orthotopic Neobladder :- An orthotopic neobladder is a surgical method where a new bladder is constructed from a segment of the intestine and connected to the urethra. This allows patients to urinate normally through the urethra. This option closely mimics natural urination and offers the best quality of life for many patients. However, not everyone is a candidate, and it requires longer surgery and a more complex recovery.

2. How to Choose the Right Type of Cystectomy

   The best type of cystectomy surgery depends on several factors including:

   • Stage and grade of bladder cancer
   • Overall health and age of the patient
   • Extent of bladder damage
   • Patient preference and lifestyle considerations
   • Surgeon’s expertise

   A multidisciplinary team including a urologist, oncologist, and reconstructive surgeon will work with the patient to determine the most appropriate approach.

Recovery and Post-Surgical Life

Recovery from cystectomy surgery varies based on the type of procedure, the patient’s health, and the type of urinary diversion chosen. Hospital stays usually range from five to ten days for radical cystectomy. Patients may need several weeks to a few months to resume normal activities.

Emotional and physical adjustment is a significant part of post-surgical life. Support groups, counseling, and rehabilitation programs can play an essential role in helping patients adapt to changes in body function and self-image.

Regular follow-up visits and imaging tests are important to monitor for cancer recurrence or complications from the urinary diversion.

Conclusion

Cystectomy is a life-changing procedure that offers hope and healing for patients facing bladder cancer and other serious conditions. Understanding the different types of cystectomy surgeries including partial and radical approaches, as well as various urinary diversion methods empowers patients to make informed decisions about their care.

By discussing options thoroughly with a medical team and considering both short- and long-term goals, patients can choose a surgical path that offers the best possible outcomes and quality of life.