Cystectomy is a big operation to remove the entire bladder. A cystectomy is usually recommended for "muscle-invasive" bladder cancers (cancers that are growing deeply into the bladder). Usually, this is done through a long incision on the abdomen, but in Nottingham we can usually perform a cystectomy using keyhole surgery (laparoscopic cystectomy).
How is a cystectomy performed?
A cystectomy if performed under a general anaesthetic (fully asleep). You will probably also have an injection in the back (epidural) to help with pain after the operation. If a keyhole operation is performed, five small cuts are made on the lower tummy to insert the keyhole instruments. If an "open" operation is performed, a cut is made from about an inch above the naval (belly button) down to the bottom of the tummy.
The whole bladder is removed. In a man, the prostate is usually removed at the same time. In a woman, it is often necessary to remove the uterus (womb). The ureter tubes that drain urine from the kidneys have to be disconnected from the bladder when it is removed.
What happens to the urine when the bladder is removed?
There are two main options. A section of the intestine can be disconnected from the rest of the bowel and used to carry urine from the ureter tubes up to the skin of the abdomen (a stoma). The urine is collected in a bag worn on the skin. This technique is called an ileal conduit.
Alternatively, a section of intestine can be made into a reservoir that can collect and store the urine. The patient can then use a catheter tube to drain the reservoir when it gets full. This means that a bag does not need to be worn, but the operation is a bit more tricky and some people are more prone to problems with this method, such as urine leakage or infections. Overall, the level of satisfaction with the two options is very similar.
What happens after the cystectomy?
Most patients stay in hospital for at least a week. The recovery time is quicker after keyhole surgery. You may not feel able to eat for several days after surgery and will need a drip. You will have some wound drains, and these are removed after a few days once the surgeon is happy. After a few days, the nurses will show you how to look after your bag (if you have one).
As it is such a big operation, there are a number of potential complications:
- bleeding, which might need a blood transfusion
- wound infection or breakdown of the wound
- clots in the leg veins or even a clot on the lung (pulmonary embolism)
- heart problems, including a heart attack (especially if you have a heart condition)
- chest infections
- leakage of urine from where the ureter pipes have been connected up
- leakage from the bowel into the abdomen
- hernia formation
- problems with the bags or stoma
Because there are many serious complications from this type of surgery, you should take every precaution to help minimise the risk of them happening. Studies have shown that one of the most important factors in preventing complication is the level of experience of the surgeon and his or her level of expertise.
In Nottingham, all such operations are undertaken by a team of specialised cancer surgeons. National statistics collected by the British Association of Urological Surgeons indicate that Nottingham has one of the highest recorded numbers of major cancer operations in the country.