Cystectomy

ABOUT CYSTECTOMY

What is a cystectomy?

Cystectomy is a procedure to completely remove the bladder.

After the bladder is removed, the flow of urine is usually diverted into a segment of bowel which is brought out onto the skin on the abdomen as a stoma. This is known as an ileal conduit.

Alternatively, sometimes it is possible to create a new bladder out of a segment of bowel, which is connected to the urethra. This is known as a neobladder.

Why is a cystectomy required?

Cystectomy is usually performed to treat aggressive life-threatening bladder cancer.

Occasionally cystectomy is performed for non-cancerous conditions, for example when the bladder has been severely damaged by interstitial cystitis or radiotherapy.

Bladder Cancer

Bladder cancer is a disease caused by the abnormal growth of cells in the bladder. It occurs when cells from the lining of the bladder (known as the urothelium), grow uncontrollably, forming a tumour that can spread to other parts of the body.

PATIENT JOURNEY

What does a cystectomy involve?

A cystectomy is performed under a general anaesthetic with you completely asleep.

Open cystectomy – We make an incision in the middle of the abdomen from the pubic bone to the level of the belly button.

Robotic cystectomy – We inflate your abdominal cavity with carbon dioxide gas to create space to perform the operation. We usually make 6 keyhole incisions in your abdomen, through which we insert the surgical instruments.

We completely remove:
• The bladder.
• In men, the prostate gland and seminal vesicles are usually also removed.
• In women, the uterus, fallopian tubes and ovaries are usually also removed.
• Sometimes the urethra is also removed.
• If the operation is for cancer, the lymph nodes surrounding the bladder are usually also removed.

What does a cystectomy involve?

Creating an ileal conduit

If we are creating an ileal conduit, a 15cm segment of small bowel is separated from the rest of the small bowel to make the conduit. One end of the conduit is joined to the ureters (tubes draining the kidneys). The other end of the conduit is brought out on the skin on the abdomen to form a stoma. Urine drains continuously via the stoma into a stoma bag. The remainder of the small bowel is joined back together.

Creating a neobladder

If we are creating a neobladder. A 40-60cm segment of small bowel is separated from the rest of the small bowel. This segment is refashioned into a reservoir which can hold approximately 150 to 250ml of urine. The neobladder is connected to the urethra and ureters. This allows you to pass urine via the urethra. The remainder of the small bowel is joined back together.

What does a cystectomy involve?

At the end of the operation Your wounds are closed with stitches or staples.

One or more drainage tubes are placed coming out of the abdomen.

Where the ureter (tube from the kidney) is joined onto the bowel, a splint known as a ureteric stent is placed to allow the join to heal. There is one stent placed in each ureter. If you have a neobladder, a catheter is placed through the urethra.

Temporary tube(s) are placed through the front wall of the bladder to the skin to divert urine while the bladder heals.

What is the recovery after cystectomy?

You may spend the first one or more nights after the procedure in the intensive care unit (ICU).

You will usually be in hospital for one to two weeks after the procedure.

You will not be able to eat normally for the first few days after the procedure because the bowel slows down. An ileus is where the bowel stops, which can take up to seven days to recover. Once the bowel starts working normally you can slowly return to eating.

The drains coming out of the abdomen will be removed while you are in hospital. The stents coming out of the ureters may be removed while you are in hospital, or at your first outpatient appointment.

If you have an ileal conduit, you will be taught how to manage the stoma bag before discharge from hospital.

OUR TEAM

The following doctors in our practice perform cystectomy:

Dr Anojan Navaratnam

Urologist

Dr Jonathan Chambers

Urologist

Dr Jason Paterdis

Urologist

Book an appointment

Book an appointment to discuss this procedure with one of our doctors.