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Radical Cystectomy by Diana Kohnle

En Español (Spanish Version)

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

A radical cystectomy is a surgery to remove the bladder.

Reasons for Procedure

Reasons for a cystectomy include:

Cancer of the bladder
Problems with nerve-muscle control of the bladder
Bladder damage from radiation or chemotherapy
Bladder damage or bleeding from other conditions, treatments, or injuries

Possible Complications

Complications occur in 25%-35% of patients who have cystectomy. If you are planning to have a cystectomy, your doctor will review a list of possible complications. These may include:

Infection
Bleeding
Loss of sexual function
Fluid build-up in the abdominal cavity
Damage to other organs
Blockage of urine flow from the ureters to the bladder
Nutrition problems (depending on the bowel segments used to create a way for urine to drain)
Blood clots
Reaction to anesthesia
Urinary incontinence

Previous surgery in the abdomen or pelvis or radiation to the area increases your risk of complications.

What to Expect

Prior to Procedure

Doctors recommend that you quit smoking before surgery. You may also need to take antibiotics to prevent infection and laxatives to clean out the bowels.

The night before, you may be asked not to eat anything and to only drink clear liquids. Do not eat or drink anything after midnight or on the morning of the procedure. This includes avoiding clear liquids, coffee, tea, and water.

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, such as:

Aspirin or other anti-inflammatory drugs
Blood thinners, such as clopidogrel or warfarin

Anesthesia

General anesthesia is given before surgery. You will be asleep.

Description of Procedure

An incision will be made in the abdomen to expose the bladder. All blood vessels to the bladder will be cut. The bladder will then be removed. Other tissues and organs may also need to be removed with the bladder.

The doctor will also need to create a new way for urine to be passed out of the body. A new bladder may be built using pieces of intestine. Or, an external bag may be attached to the abdomen.

Kidneys, Ureters, and Bladder

How Long Will It Take?

About 3–6 hours

How Much Will It Hurt?

Anesthesia will prevent pain during the surgery. Recovery is usually painful. Your doctor will give you medicine to help manage the pain.

Average Hospital Stay

The usual length of stay is 5-12 days. The specific length of time will depend on your condition and the reason for surgery. Your doctor may also choose to keep you longer if complications occur.

Post-procedure Care

At the Hospital

A stay in the intensive care unit for 2-3 days may be needed.
During surgery, a tube will be placed from the nose to the stomach. It will stay there for several days. Because you cannot eat with the tube in place, you will receive IV fluids.
If a urine bag was attached during the surgery, you will be taught how to dispose of urine.

At Home

When you return home, do the following to help ensure a smooth recovery:

Difficult physical activity should be avoided for 4-6 weeks.
Avoid heavy lifting, straining, and sexual activity until your doctor tells you it is okay.
Driving and climbing stairs is usually allowed. Ask your doctor about any restrictions.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
Be sure to follow your doctor's instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, heavy bleeding, or discharge from the incision and/or stoma site
Nausea and/or vomiting
Pain that you cannot control with the medicines you have been given
Inability to urinate or difficulty urinating, extreme cloudiness or pus in the urine, a bad odor to the urine
Cough, shortness of breath, or chest pain

In case of an emergency, call for medical help right away.

RESOURCES:

National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov/
Urology Care Foundation http://www.urologyhealth.org/

CANADIAN RESOURCES:

Canadian Urological Association http://www.cua.org/
Public Health Agency of Canada http://www.phac-aspc.gc.ca/

References:

Bladder cancer facts. AP John Institute for Cancer Research website. Available at: http://www.apjohncancerinstitute.org/cancer/bladder.htm . Accessed December 17, 2012.
Campbell M, Wein A, Kavoussi L. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: WB Saunders; 2007.
Cystectomy information binder. Johns Hopkins Medicine website. Available at: http://urology.jhu.edu/bladder/Cystectomy.pdf . Accessed December 17, 2012.
Maffezzini M, Campodonico F, Canepa G, Gerbi G, Parodi D. Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. Surg Oncol . 2008;17(1):41-48.

Last reviewed November 2012 by Adrienne Carmack, MD

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