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A cystectomy is a surgical procedure to remove the bladder. Removal can be done in whole (radical) or in part. This procedure is often performed to treat advanced bladder cancer.

The bladder is an organ that holds urine in the body before it is finally excreted. A cystectomy is generally performed if the cancer has grown to reach the muscle layer of the bladder. However, this procedure can also be performed to treat other conditions that affect the bladder and urinary system.

Cistectomy or cystectomy is of two types:

Partial cystectomy

Partial cystectomy is performed by removing part of the bladder and repairing part of the other. In this procedure, the lymph nodes near the tumor will also be removed to check for any spread of cancer outside the bladder.

Radical cystectomy

Radical cystectomy is performed by removing the entire bladder and some of the surrounding lymph nodes. In men, this surgery also includes cutting the ducts that carry sperm (vas deferens) and removing the prostate and seminal vesicles.

In women, the doctor will also remove the uterus, cervix, fallopian tubes, ovaries, and sometimes also part of the vaginal wall.

Indications and contraindications for cystectomy

Cistectomy may be performed to treat the following conditions:

• Bladder cancer or cancer around the bladder that progresses to the bladder
• Birth disorders affecting the urinary system
• Neural disorders affecting the urinary system
• Inflammation of the bladder (cystitis) which causes severe damage to the bladder

The type of cystectomy performed depends on the underlying disease, the patient's medical condition, and the patient's preferences.

Partial cystectomy

Partial cystectomy can be performed in patients with the following conditions: the following ai:

• Advanced cancer located in only one place
• Cancer located away from important structures
• Cancer has not spread to the neck of the bladder or prostate
• Cancer has not spread (metastasized) to parts of the body far from the bladder
• The bladder is still functioning well after surgery
• Never had radiation therapy

Radical cystectomy

Radical cystectomy should be performed under the following conditions:

• Your cancer is a type of cancer. squamous cell carcinoma (SCC), sarcoma, or adenocarcinoma
• Cancer has grown to most of the muscle layer of the bladder, with or without spread to other parts of the body
• Cancer has spread to prostate
• Cancer has metastasized
• Cancer cannot be treated with other procedures, such as chemotherapy or immunotherapy
• Cancer causes pain, bloody urine ( hematuria), or significant urinary disturbances
• Cancer recurs despite transurethral resection of bladder tumor (TURBT) or other treatment methods.

It should be noted that radical cystectomy is not intended for elderly patients. This procedure also cannot be performed if the spread of the cancer is too severe and the risk of bleeding is very high.

Cistectomy Warning

Cystectomy can cause significant changes in the cystectomy. daily routine, especially if a radical cystectomy is being performed. Therefore, it is important for patients to understand the benefits and risks of this surgery, as well as what changes need to be anticipated.

Patients who have undergone radical cystectomy cannot have children in the future. Therefore, the decision to undergo this surgery needs to be discussed with the doctor with the partner and family.

If the bladder cancer patient is still planning to have children, ask the doctor about options other than radical cystectomy that are still possible and safe to have.

Before Cystectomy

Before undergoing a cystectomy, the patient needs to be consulted regarding the conditions that may be experienced after undergoing this procedure. In addition, there are preparations that patients need to do before surgery, including:

• Informing the doctor about the drugs that are being taken, because the doctor may ask the patient to change or stop taking certain medications
• Quit smoking, because smoking can increase the risk of side effects after a cystectomy
• Take some additional tests, such as blood tests or a scan with X-rays or CT Scans, in preparation for surgery
• Preparing a companion who can help while in the hospital and take the patient home, because the patient will be prohibited from driving a vehicle after the operation

Cistectomy Procedure

A cystectomy usually lasts 4–6 hours. To start the cystectomy procedure, the nurse will attach an IV tube to the patient. The nurse will also give medication to relieve pain and nausea, which may appear during and after the operation.

After that, the patient's body will be connected to a monitor screen. The patient will also be given blood-thinning medication to prevent blood clots, and antibiotics to prevent infection. Next, the nurse will give general anesthesia, so that the patient is asleep during the procedure.

The cystectomy procedure can be performed by two surgical methods. Here's an explanation:

Open cystectomy

Open cystectomy is performed by making one long incision in the abdomen. The doctor's hand will then enter the abdominal cavity to perform the procedure to remove the bladder.

Minimally invasive cystectomy

Minimally invasive cystectomy is performed with the help of a laparoscope or robot. The operation begins by making several small incisions in the abdomen. Through one of these incisions, the doctor will insert carbon dioxide to inflate the stomach. This is intended to make it easier for the doctor to see the condition in the stomach.

Through another incision, the doctor will insert a laparoscope tube equipped with a camera and some special surgical instruments. The surgical instrument can be controlled directly using the doctor's hand or connected to a surgical robot that can move more accurately.

After the cystectomy is complete, the doctor will rebuild a new urinary tract, as a way for urine to exit the body. The creation of a new urinary tract can be done in three ways:

Ileal canal

The ileal canal is created by cutting a portion of the small intestine. This piece will then be connected to the ureter, which is the tube that carries urine from the kidney to the bladder. The other end of the piece of small intestine will then be attached to an opening in the skin (stoma), which is usually made on the right side of the abdomen near the navel.

In the stoma, a bag will be attached to collect urine that comes out of the body. The collected urine can be discarded when the bag is full.

Urine container in the stomach

The doctor will make a new urine container using a larger piece of intestine . After that, the other end of the container will be attached to a valve stoma in the skin of the abdomen. The valve will keep the urine in the container from escaping. However, this valve can be inserted into a small tube (catheter), so that urine can be passed periodically.

New bladder reconstruction (neobladder)

New bladder reconstruction (neobladder) is done by creating a new urine container inside the body, using a long piece of small intestine. The new container is made where the bladder was originally located.

One end of the piece of intestine will then be attached to the ureter, while the other end is attached to the urethra, the tube that carries urine from the bladder out of the body.

Patients who have undergone a new bladder reconstruction, will not feel the urge to urinate. Therefore, a schedule for urination must be determined.

Urine can be expelled from the container normally, by relaxing the pelvic muscles and tightening the abdominal muscles. However, sometimes patients need to use a catheter to drain urine.

Please note, some patients may also experience an inability to control the flow of urine (urinary incontinence) after undergoing this procedure.

After this procedure. Cystectomy

After regaining consciousness and the patient's condition has stabilized, the patient will be taken to the recovery room to rest for a few hours. After that, the patient will be taken to the inpatient room. The patient must stay in the hospital for 5–6 days, usually until the intestines can function normally in absorbing fluids and nutrients.

The day after the procedure is complete, the patient will be advised to get up and walk frequently. This is useful for accelerating the healing process and restoring intestinal function, increasing blood circulation, and preventing muscle cramps and blood clots.

Pain may appear around the incision for several weeks. However, the pain will gradually subside as the healing process progresses.

Patients also need follow-up care in the first week after the cystectomy, and several months afterward. During this session, the doctor will perform an examination to ensure that urine can drain properly and that the patient does not have electrolyte disturbances.

If a cystectomy is performed to treat bladder cancer, the patient will also be advised to undergo an examination to the bladder. doctor regularly. This is to ensure that the cancer does not reappear.

In addition to the above, the patient will also experience several changes after surgery, including:

Changes in urination

If the bladder is replaced with an ileal canal or a urine container in the abdomen, the patient will still experience a 6–8 week discharge from the surgery. The fluid will usually gradually change color from red, pink, brown, to yellow.

Meanwhile, in patients undergoing a new bladder reconstruction, the urine that comes out may be mixed with blood. However, within a few weeks, the color of the urine will return to normal.

The procedure for replacing the bladder after a cystectomy will also cause the urine to mix with mucus. This happens because the part of the intestine that is used as a substitute for the bladder does normally produce mucus. Over time, mucus production will decrease, although it will remain.

Changes in daily activities

During the 6–8 weeks after surgery, the patient may need to limit activities, such as lifting weights, driving, bathing, and going to school or work. The patient may also need to temporarily stop sexual activity, so that the healing process can proceed properly, until the patient's condition improves periodically.

Although a cystectomy can affect daily activities, patients are generally able to lead a normal life. Patients with ileal tract may have to get used to carrying a urine bag on their stomach at all times. However, most patients will quickly get used to this.

In patients undergoing neobladder, it is important to follow the doctor's advice regarding the schedule of urination, which is a maximum of every 4 hours. Therefore, patients should make a schedule to urinate every day. This is to prevent the neobladder from becoming too large and difficult to empty.

Changes in sexual activity

Patient will also experience changes in having sex. In male patients, nerve damage that may occur during surgery can affect the ability to get an erection. But generally, the condition improves on its own over time.

Male patients will still be able to orgasm as usual. But keep in mind, patients who undergo radical cystectomy will lose the ability to ejaculate, secrete semen and produce sperm. In other words, patients can no longer have children after surgery.

For female patients, changes to the vagina after surgery can make sex less comfortable. Nerve damage can also affect arousal and the ability to reach orgasm. In patients undergoing radical cystectomy, the ovaries will also be removed, so the patient cannot have children.

For patients who use a stoma, sexual intercourse can still be performed and will not cause pain in the stoma. To prevent leakage of the stoma, it is recommended to empty the stoma before having sex. Patients can also use protection, such as a pouch closure, to keep the stoma secure.

Side Effects of Cystectomy

Cystectomy is a procedure that requires many changes to the internal organs in the body. stomach, so it's quite complicated to do. As a result, side effects are possible, which include:

• Bleeding
• Blood clots
• Heart attack
• Infection
• Pneumonia

The above side effects can be prevented by thorough preparation before surgery.

Cistectomy also causes changes in the bladder and small intestine. , so that other side effects can occur such as:

• Dehydration
• Electrolyte balance disorders
• Urinary tract infections
• Clogs that cause food or liquid cannot pass through the intestines (bowel obstruction)
• Obstruction of one of the urinary tracts from the kidney (blockage of the ureter)

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